ASAM Weekly for May 23th, 2023
This Week in the ASAM Weekly
Recovery capital is a conceptual framework for recovery, but the balance of social, physical, human, and cultural capital does shape an individual's experience of addiction (Drug and Alcohol Dependence). It’s a relevant theme in this week's publications.
According to recent CDC data, there were 110,000 drug overdose deaths this year but hopefully a plateau represents the successes of our interventions and not a low tide before a new wave (NY Times). The pandemic exacerbated the already concerning state of adolescent mental health (including overdoses), and although 2022 data showed an improvement, girls are faring worse than before (MMWR). Racial inequality in OUD treatment persists- beyond discrepancies in access to care -- because of a harmful balance of racism, stigma, and trust (NEJM).
When broadly responding to these challenges we are also trying to correct some of the capital imbalances mentioned above. Increasing access to methadone could help with cultural capital, but we need to go further than the Biden administration is proposing (STAT News) and provide office-based methadone treatment (Medpage Today). Protecting individuals who use cannabis from the harms of psychosis could improve human capital, but our experience of connecting tobacco use to lung cancer is cautionary (World Psychiatry). Innovation in animal models will further our understanding of disease states, but scientists acknowledge that the utmost importance is a broader, multidisciplinary approach to improve the human condition (ACS Chemical Neuroscience).
Thanks for reading,
Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM, Debra R. Newman, PA-C, MSPAS, MPH, Jack Woodside, MD, John A. Fromson, MD
Racial Inequality in Receipt of Medications for Opioid Use Disorder
The New England Journal of Medicine
Opioid overdose mortality has increased over the last ten years, but disproportionately among Black persons. The authors examine racial disparities in receipt of buprenorphine and naloxone after opioid use disorder (OUD) related events using Medicare data from 2016-2019. They found that Black persons were less likely to receive buprenorphine (12.7 vs 23.3%) and naloxone (14.4% vs 22.9%) than White persons within six months after the event. Further, Black persons received lower day supply of buprenorphine and were less likely to be retained on treatment. Of note, Black and White persons had similar rates of ambulatory visits in the 6 months after the event, indicating patient and provider-level barriers to access.
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Research and Science
Development and psychometric properties of the Multidimensional Inventory of Recovery Capital 🔓
Drug and Alcohol Dependence
Recovery capital comprises the social, physical, human, and cultural resources that help people resolve alcohol and other drug problems. This study reports on process and psychometric outcomes for the Multidimensional Inventory of Recovery Capital (MIRC), a novel measure of recovery capital. Researchers used a three-phase, mixed methods approach to develop the MIRC. Results confirm the psychometric strength of the MIRC and underscore the importance of incorporating the insights of diverse samples of people in recovery. The MIRC holds promise as an assessment tool in future research and is available for use at no cost in treatment and community-based settings.
Nicotine receptor partial agonists for smoking cessation 🔓
Cochrane Database of Systematic Reviews
This updated Cochrane review sought to assess the efficacy of nicotine receptor partial agonists (NRPAs) in smoking cessation. When compared to placebo or no medication, the NRPAs cytisine and varenicline were more efficacious, with cytisine resulting in fewer SAEs than varenicline. Pooled results from studies comparing cytisine and varenicline demonstrate that varenicline helps more people stop smoking. Varenicline is also superior to bupropion and NRT at helping people quit. Future studies could consider a number of factors, including comparisons of e-cigarettes vs these pharmaceutical options.
Nonfatal Overdoses Among Pregnant Individuals With Opioid Use Disorder
Obstetrics and Gynecology
This study collected details of prior overdoses from 102 pregnant patients receiving prenatal care and treatment for OUD. All patients had a diagnosis of severe OUD; 83% had a diagnosis of depression and 65% a diagnosis of anxiety. Two-thirds (65%) reported a prior overdose, one-third (34%) reported three or more; some 41% of these were in the prior year. The most common substances used were opioids (82%) and sedatives (30%). The authors conclude that prior overdoses are common among treatment-seeking pregnant individuals and advise interventions (MOUD, naloxone, fentanyl test strips, not using alone, etc.) to prevent overdoses.
Emergency Department Visits Involving Mental Health Conditions, Suicide-Related Behaviors, and Drug Overdoses Among Adolescents — United States, January 2019–February 2023 🔓
Morbidity and Mortality Weekly Report
In this study, the authors examine trends in emergency department (ED) visits among adolescents between Jan 2019 and Feb 2023 for mental health conditions (MHC), including suicide and overdose. While there was variability during different periods of the year, there was an increase in MHC visits after the start of the COVID pandemic. However, there was a decrease in weekly ED visits by fall of 2022, compared to 2021, for MHCs overall and for suicide-related and drug overdose visits, among females in particular. However, ED visit rates among females in fall of 2022 were still above pre-pandemic rates. The authors support prioritizing evidence-based prevention and trauma-informed early interventions and treatment strategies and improvements to accessible behavioral health care.
All Hands on Deck: We Need Multiple Approaches To Uncover the Neuroscience behind the Opioid Overdose Crisis
ACS Chemical Neuroscience
Preclinical research aims to better understand the underpinnings of OUD. The authors suggest that trends in opioid use should be considered when designing this research. Barriers such as continued stigma and lack of available treatment thwart progress in disease management; these also negatively impact harm reduction efforts. Cultural competence is also needed to address the impacts of the opioid crisis in historically marginalized communities. Researchers need to support multiple models to promote new perspectives and discoveries. The authors suggest that it will take a multidisciplinary approach to implement the strategies necessary to tackle this crisis.
Tusi: a new ketamine concoction complicating the drug landscape
The American Journal of Drug and Alcohol Abuse
This paper describes an emerging drug concoction intended to mimic a group of phenethylamines (2C) with psychedelic, stimulant, and entactogenic effects. This emerging drug concoction is known as tusi (phonetic for “2C”) and has been found in Latin America, Europe, and recently in the US. Despite the name, tusi does not contain any of the 2C phenethylamines. It most commonly contains ketamine often combined with MDMA and may also contain cocaine, methamphetamine, opioids, or other substances. The authors are concerned that people may assume they are using 2C-B and not be aware of the actual substances they are using. Researchers may also be misled. They recommend education about this increasingly popular drug concoction.
Cannabis, cannabinoids and psychosis: a balanced view 🔓
Epidemiological studies link cannabis exposure to a higher risk (2‐ to 4‐fold) for schizophrenia. The dose‐response relationship is linear, such that more frequent and heavier use, and use of higher potency cannabis, carries a greater risk. Other moderating factors include an earlier age of exposure, childhood trauma, and exposure to other drugs. Cannabis also has a negative impact on the course of schizophrenia, with greater positive symptoms, relapse rates, emergency department visits, hospitalizations, homelessness, and legal problems. Genome‐wide association studies (GWAS) provide evidence for a bidirectional causal relationship between cannabis use and schizophrenia but suggest a larger contribution of reverse‐causal mechanisms and common genetic risk for both schizophrenia and cannabis use (genetic confounding).
In The News
Addiction Doc Urges Lawmakers to Rethink Methadone Prescribing Restrictions
Cops say they're being poisoned by fentanyl. Experts say the risk is 'extremely low'
U.S. Recorded Nearly 110,000 Overdose Deaths in 2022
The New York Times
Drug czar: ‘All options are on the table’ for methadone access
Remote Work Comes With Daytime Drug and Drinking Habits
Walgreens to pay San Francisco $230 million to settle opioid lawsuit
A Rural County’s Choice: Use Opioid Funds to Pay Off Debt, or Pay Them Forward to Curb Crisis
KFF Health News