Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention 🔓
This very comprehensive update on SUDs by Dr. Nora Volkow covers topics such as classification and prevalence, neurobiology, risk factors, clinical aspects, treatment, prevention, and special populations. Strategies for prevention, especially if adopted in childhood and adolescence, can decrease SUD risk along with that of other mental illnesses. Evidence of clinically significant benefit exists for medications, behavioral therapies and neuromodulation (specifically in the treatment of nicotine use disorder). The authors discussed the importance of treatment within the context of a Chronic Care Model, with interventions targeted to the severity of the disorder and concomitant treatment of physical and mental health conditions.
Fentanyl and Other Opioid Use Disorders: Treatment and Research Needs
The American Journal of Psychiatry
The opioid overdose epidemic, which has been markedly exacerbated by fentanyl, highlights the urgency for psychiatrists to be well versed on the proper screening and management of opioid use disorder (OUD). This overview provides a brief review of opioid pharmacology, the neurobiology of opioid addiction (corresponding to moderate and severe OUD), and treatments and promising interventions, and outlines some knowledge gaps and research needs, particularly in relation to fentanyl.
Prescribed and Penalized: The Detrimental Impact of Mandated Reporting for Prenatal Utilization of Medication for Opioid Use Disorder 🔓
Maternal and Child Health Journal
Mothers who use opioids during pregnancy are often referred to child protective services (CPS), but in some states, including Massachusetts, mandatory reporting is required even for mothers taking medications for opioid use disorder (MOUD). The authors conducted interviews of mothers with OUD (24 taking MOUD, one stopped MOUD prior to delivery, one taking non-prescribed opioid) about the impact of this policy. The mothers reported three main themes: 1) they perceived the mandate as discriminatory, unjust and stigmatizing; 2) mandated reporting caused stress and negatively impacted family health and wellbeing; and 3) mandated reporting policies influenced medical decisions about accessing MOUD during pregnancy. The authors note that while this policy may be designed to identify infants at risk, it causes harm to families and potential negative impact on uptake of MOUD during pregnancy.
Alcohol Misuse and Gun Violence: An Evidence-based Approach for State Policy 🔓
The Consortium for Risk-Based Firearm Policy & the Center for Gun Violence Solutions at the Johns Hopkins Bloomberg School of Public Health
Together, the Consortium for Risk-Based Firearm Policy and the Johns Hopkins Center for Gun Violence Solutions developed this comprehensive report with alcohol and gun policy recommendations. Its aim is to highlight research to inform policy. Despite alcohol being a significant risk factor for gun violence, few attempts have been made to address the interplay between them. Summarized are the connections between alcohol and firearm use, existing state laws, and a core set of recommendations for addressing the problem.