American Society of Addiciton Medicine

ASAM Weekly for June 6th, 2023

by ASAM Weekly Editors

This Week in the ASAM Weekly

A scoping review from The Lancet Psychiatry demonstrates how racism in multiple systems has contributed to an overdose death rate for which Black Americans have surpassed White Americans. Inequities in treatment access are part of the problem, so the success of an integrated mobile medical unit providing low-threshold buprenorphine treatment in a majority African-American population is noteworthy (Journal of Substance Use and Addiction Treatment). It also shows how inequities in addiction treatment are part of inequities in public health, so providing integrated public health services is a humane goal. Unfortunately, too many (bipartisan) politicians will reflexively dehumanize addiction and default toward attempts of incarcerating our way out of a public health crisis (The Hill).

The debate around cannabis and psychosis continues. A large, genome-wide association study has brought us further in our understanding of the shared genetic risk for cannabis use and psychotic illness (The Lancet Psychiatry) while a population-based cohort study from Denmark indicates cannabis use is associated with an increased risk for both psychotic and nonpsychotic bipolar and unipolar depression (JAMA Psychiatry). It’s becoming more evident that a subset of the population has “co-occurring” genetic vulnerabilities, and we need to be careful how cannabis policies affect them.

The FDA has been making important decisions on addiction. The authorization of OTC naloxone was advocated for and is now welcomed, but cost and insurance coverage may become a hindrance (Lancet Regional Health). Brixadi was recently approved for OUD, giving us more choices and dosing options for extended-release buprenorphine (FDA).

Before you go, there have been improvements in screening for HIV and Hepatitis B/C in Medicaid enrollees receiving MOUD, but a majority are still not getting tested (Clinical Infectious Diseases). Screening for these infections and linking individuals to treatment presents an opportunity to improve public health inequities for our patients. 

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

Lead 

Increasing overdose deaths among Black Americans: a review of the literature

The Lancet Psychiatry

This scoping review analyzed the many and varied factors contributing to the recent rise in opioid overdose death rates among Black Americans. Differences in structural and social determinants of health; unequal access, use, and continuity of SUD and harm reduction services; variability in fentanyl exposure and risk; and changes in social and economic conditions were all found to play a role. Black Americans historically are less likely to have access to treatment services than White Americans. Work to reform the criminal legal system, expand access, address provider bias, and fund equity-improving programs need to happen to affect change.

Publications Council Member Applications are Open

The Publications Council is charged with overseeing ASAM publications. The Council identifies publication topics, evaluates proposals for new publications, ensures adequate publisher performance, and regularly furnishes the Board of Directors with updates on publication activities.

To learn more about the position, click here. 

 

Research and Science

Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder

JAMA Psychiatry

This cohort study of 6,651,765 individuals in Denmark was designed to determine if cannabis use disorder is associated with an increased risk of psychotic and nonpsychotic unipolar depression and bipolar disorder. Results indicate that cannabis use disorder was associated with an increased risk of both psychotic and nonpsychotic unipolar depression and bipolar disorder. The findings suggest that cannabis use disorder is independently associated with bipolar disorder and unipolar depression.

The relationship between cannabis use, schizophrenia, and bipolar disorder: a genetically informed study

The Lancet Psychiatry

This study used several large genetic databases to identify genetic loci associated with schizophrenia, bipolar disorder, lifetime cannabis use, and cannabis use disorder. Overall, the authors found the psychotic disorders (schizophrenia and bipolar disorder) to be more heritable than the cannabis phenotypes (lifetime cannabis use and cannabis use disorder). A total of 57 genetic loci were associated with more than one of these conditions. Mendelian randomization techniques were used to estimate the causal relationship between psychotic disorders and cannabis phenotypes and found evidence of bidirectional causality. The authors conclude that a shared genetic component is responsible for the link between psychotic disorders and cannabis use.

DEA

Prevalence of Testing for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Among Medicaid Enrollees Treated With Medications for Opioid Use Disorder in 11 States, 2016–2019

Clinical Infectious Diseases

This study obtained Medicaid claims and enrollment data from 11 states. A total of 390,053 episodes of MOUD initiation between 2016 and 2019 were included and determined if testing for HIV, HBV, and HCV was performed within 90 days of MOUD initiation. Between 2016 and 2019, testing for HIV increased from 20% to 25% of enrollees, for HBV from 22% to 25%, and for HCV from 24% to 27%. Testing for all 3 diseases increased from 15% to 19%. Patients receiving methadone from OTPs and those initiating MOUD with naltrexone were significantly less likely to be tested. Although testing rates improved over time, three-quarters of those initiating MOUD were not tested.

Learn More

Promises and perils of the FDA's over-the-counter naloxone reclassification 🔓

The Lancet Regional Health

In this commentary, the authors recognize the significant potential benefits in addressing overdose deaths due to opioid use disorder (OUD) by making naloxone available over the counter (OTC), but they also point out potential risk. Availability of naloxone OTC most significantly should increase the general availability and presence in the community, potentially reduce stigma, and incentivize other pharmaceutical companies to produce naloxone. However, there is the significant risk that reclassification to OTC could result in decreases in coverage by insurance and increases in cost to consumers, which could potentially limit access, particularly among most vulnerable populations with low income. 

Comparative acute effects of mescaline, lysergic acid diethylamide, and psilocybin in a randomized, double-blind, placebo-controlled cross-over study in healthy participants 🔓

Neuropsychopharmacology

This study used a randomized, double-blind, placebo-controlled, cross-over design to compare the acute subjective effects, autonomic effects, and pharmacokinetics of typically used, moderate to high doses of mescaline (300 and 500 mg), LSD (100 µg), and psilocybin (20 mg) in 32 healthy participants. Researchers found no evidence of qualitative differences in altered states of consciousness that were induced by equally strong doses of mescaline, LSD, and psilocybin. The results indicate that any differences in the pharmacological profiles of mescaline, LSD, and psilocybin do not translate into relevant differences in the subjective experience.

Outcomes of a mobile medical unit for low-threshold buprenorphine access targeting opioid overdose hot spots in Chicago 🔓

Journal of Substance Use and Addiction Treatment

This retrospective cohort study describes the Chicago-based Community Outreach Intervention Project's (COIP) integrated mobile medical program. The study focused on providing low-threshold buprenorphine and primary care to Chicago communities with the highest overdose rates. Over a one-year period, the unit successfully served nearly 600 patients, with some patients initiating treatment with buprenorphine after presenting for other health concerns. This integrated approach can therefore reach people struggling with OUD who are not yet ready to start treatment.

Assessment of Screening Tools to Identify Substance Use Disorders Among Adolescents 🔓

JAMA Network Open

In this study, researchers examine 3 substance use screening tools: 1) Screening to Brief Intervention (S2BI), 2) Brief Screener for Tobacco, Alcohol, and Drugs (BSTAD), and 3) Tobacco, Alcohol, Prescription Medication, and Other Substances (TAPS) in adolescents. The authors utilized the recommended screening tool cutoffs and found all 3 tools had adequate properties to identify substance use disorders compared to DSM-5 diagnostic criteria for nicotine, alcohol, or cannabis use disorder. They did not find a significant difference between the tools in this study but did note additional work should be done to determine if one tool has differing properties in different populations.