ASAM Weekly for October 25, 2022
This Week in the ASAM Weekly
Opioid use disorder has a strong association with suicidal behaviors. Over the past decade, rates of suicidal ideation in adults who use opioids have increased substantially without a comparable increase in mental health service use. These findings, based on data from NSDUH, highlight a subset in the addiction treatment gap (co-occurring disorders) and the growing link between suicide and overdose risk (eClinical Medicine).
The benefits of MOUD are truly remarkable, so closing the treatment gap is not only important for the overdose crisis but it is also important with respect to establishing an addiction-treatment infrastructure that supports universal treatment going forward (NEJM). Part of this will require scaling up harm-reduction programs, but there are legal barriers made up of state-dependent, drug-paraphernalia laws which require federal leadership to bring about change (NEJM). New York State, on the other hand, is one of the first states to implement a naloxone administration program for law enforcement. It is a practical strategy for the overdose crisis, but questions remain about the mistrust people who use drugs have toward police (Harm Reduction Journal).
There are a few other newsworthy topics this week. Similar to safe-storage education about guns, medications, and Tide pods, parents should be screened and educated about accidental ingestion of cannabis edibles (JAMA Pediatrics). Misuse of antihistamines, although uncommon, is something to monitor more closely, especially when mixed with opioids (CDC). And leave it to the Los Angeles Times to name the IKEA store in Burbank, CA as one the scariest places in LA to visit when high. What’s the Swedish word for “spooky”?
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
National Survey on Drug Use and Health (NSDUH) data were used to examine trends in suicidal ideation (SI) between 2009 and 2020 among adults aged 18 or older with OUD. From 2009 to 2020, the prevalence of individuals with OUD who reported SI increased significantly from 22.8% to 29.8%. The subgroups with the most significant changes included young adults, females, non-Hispanic whites, working full-time, individuals with Medicaid, living in a large metropolitan areas, and having another SUD. Among those with past-year OUD, over half with SI reported needing mental health treatment in the past year but not receiving it.
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
JAMA Network Open
In this randomized clinical trial that included 1514 adolescents, Real Cost vaping prevention advertisements reduced susceptibility to vaping compared with control videos. Real Cost advertisements also reduced susceptibility to smoking cigarettes compared with control videos. These findings suggest that vaping prevention advertisements reduced the extent to which youth were open to vaping and also had beneficial effects on cigarette smoking outcomes.
Journal of Studies on Alcohol and Drugs
This cohort study examined the impact of alcohol use on geriatric comorbidities among persons living with HIV (PLWH) in New Orleans between 2015 and 2017. Alcohol consumption increased significantly between the teen years and midlife (31–40), declining thereafter through ages 50–60. Significant interindividual differences were observed in all trajectory parameters. Persons with higher starting points of alcohol consumption showed worse mental health (depression and anxiety) and social experiences (homelessness and incarceration history) at study baseline. A steeper increase in volume of alcohol consumption after ages 10–20 was associated with worse health-related quality of life, greater frailty and comorbidities, and greater odds of current heavy drinking.
Harm Reduction Journal
In response to the opioid epidemic and increasing overdose mortality, efforts have been made to increase distribution of naloxone in the community. In New York State those efforts included providing law enforcement with training and naloxone to use as first responders. In this study, the authors evaluate program outcomes from 2015 to 2020. During that period law enforcement documented providing naloxone to 9133 individuals, with 87.4% confirmed to survive, 5.7% outcome unknown, and 6.9% deceased. In 86% of cases, law enforcement was the first to arrive on the scene and the average wait for EMS arrival was 5.95 minutes. While there may be concerns about law enforcement response to overdoses, this study across rural, suburban, and urban settings demonstrates the potential of these programs to save lives.
THC-infused edibles such as gummies resemble children’s candy and inappropriate storage places young children at risk of ingestion and toxic effects. In this viewpoint, the authors call for immediate action to change the current trajectory of unintentional pediatric ingestion of edible cannabis products. Pediatric clinicians are at the forefront of this crisis and can change this trajectory. Standardized screening tools are practical for pediatric injury prevention; use of these would provide opportunities to identify, intervene, and prevent future unintentional ingestions for children at risk. Advocacy to protect children is also required, looking at packaging, doses, and forms of cannabis that are being sold.
New England Journal of Medicine
This article notes that only a small percentage of people with OUD receive MOUD and lists six proposals to improve access. First, increase MOUD content in medical education. Second, increase availability of low-threshold buprenorphine access with flexible (monthly) scheduling and no requirement for counseling. Third, telemedicine for MOUD which, during COVID, has shown encouraging treatment retention and decreases in opioid use. Fourth, provide MOUD for people incarcerated to reduce the extraordinarily high overdose risk after release. Fifth, address social determinants of health. Finally, take steps to reduce stigma, both in healthcare and the community.
New England Journal of Medicine
President Biden’s 2022 State of the Union Address called for expansion of syringe Service Programs (SSPs) as part of a plan to address drug overdoses. However, many state laws present barriers to SSPs. Many state paraphernalia laws outlaw the possession of syringes and fentanyl test strips. Twelve states criminalize the distribution of sterile syringes. Even some laws authorizing SSPs require local approval or permit possession of syringes by SSP staff but not participants. The authors call for “full repeal of state drug paraphernalia laws.” This could be facilitated by making repeal a condition of federal grants as well as expungement of records for paraphernalia crimes.
Misuse of antihistamines has previously been documented, primarily in adolescents and young adults, and it has also been found as an adulterant in the illicit drug supply. As antihistamines, particularly H1 subtypes, have anticholinergic effects, including sedation, the authors evaluate the prevalence of antihistamine involvement in overdose deaths. Utilizing the State Unintentional Drug Overdose Reporting System, they evaluated 92,033 overdose deaths in 2019-2020 and found 14.7% were antihistamine positive during postmortem and 3.6% reported antihistamine as a cause of death. Most antihistamine deaths involved co-involved opioids (82.8%). While antihistamine involvement could reflect appropriate use for allergies or unknowing use from adulteration, it is important to be aware of his potential risk.
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