American Society of Addiciton Medicine

ASAM Weekly for July 4th, 2023

by ASAM Weekly Editors

This Week in the ASAM Weekly

The enthusiasm for psychedelics is incredible but the momentum is something else entirely. Thousands descended on Denver for a psychedelic conference hosted by the Multidisciplinary Association for Psychedelic Studies (MAPS), including medical professionals, entrepreneurs, politicians, along with 21st-century hippies (NPR). Drs. Gordon (NIMH), Volkow (NIDA), and Koob (NIAAA) write about the incredible potential for rapid-acting psychotherapeutics -- from neuromodulation to psychedelic medicine -- along with considerations to achieve sustainable and transformative results (Neuropsychopharmacology). So it would otherwise be remarkable that a publication involving translational neuroscience garners over 100k views in two weeks, but when it demonstrates a unifying mechanism for psychedelics that involves re-opening critical learning periods in the brain... it’s momentous (Nature). 

In comparison, the energy around e-cigarettes can almost seem subdued, but it isn’t. Total sales of e-cigarettes increased over 46% in two years, with concerns about increased sales of disposable products with youth-appealing flavors (MMWR). Wrapped up in these data are unauthorized sales, which led to a recent FDA surveillance blitz and the identification of the two most popular culprits, Elf Bar and Esco Bars (FDA). But the moral of the news story is not so straight forward as there is a need to balance between discouraging youth to vape while simultaneously encouraging adult smokers to switch, which requires nuanced yet straight-forward messaging (PLOS One).

Unfortunately, personal narratives that usually help in harm reduction messaging may not be as effective in the presence of racism or NIMBYism, but there are strategies to consider for overcoming this (International Journal of Drug Policy). Take for example the narratives of two NY Times articles and consider how they might or might not build public support around an issue -- a friend dies from a fentanyl overdose while the other gets charged with murder (NY Times), and a mother loses custody of her child because she was taking buprenorphine (NY Times).

If only there was a way to collectively reopen everyone’s social reward learning periods, then society might experience more sustained empathy for each other.

Enjoy your holiday whether it be with friends, family, or the ASAM Weekly :)

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 

Psychedelics reopen the social reward learning critical period 🔓

Nature

Psychedelics have been used for millennia in both spiritual and medicinal contexts, and a number of recent clinical successes have spurred a renewed interest in developing psychedelic therapies. This study demonstrates in mice that the ability to reopen the social reward learning critical period is a shared property across psychedelic drugs. Notably, the time course of critical period reopening is proportional to the duration of acute subjective effects reported in humans. Furthermore, the ability to reinstate social reward learning in adulthood is paralleled by metaplastic restoration of oxytocin-mediated long-term depression in the nucleus accumbens. Finally, identification of differentially expressed genes in the ‘open state’ versus the ‘closed state’ provides evidence that reorganization of the extracellular matrix is a common downstream mechanism underlying psychedelic drug-mediated critical period reopening.

Call for Applications: 4th Edition Adolescent Committee

ASAM is seeking experts in specific topic areas to serve on writing committees for the 4th Edition of The ASAM Criteria®, Adolescent Volume. These writing groups will be chaired by Lead Editors who report to the Editor-in-Chief. ASAM members and non-members are encouraged to apply, as are all members of the addiction medicine care team. Applications will be accepted through July 21, 2023.

Learn more here.


Prevalence and clinical impact of alcohol withdrawal syndrome in alcohol-associated hepatitis and the potential role of prophylaxis: a multinational, retrospective cohort study - eClinicalMedicine 🔓

eClinical Medicine

In this multinational, retrospective cohort study, the impact of alcohol withdrawal syndrome (AWS) on patients with alcoholic hepatitis (AH) was investigated. Lower platelet levels and past history of AWS were associated with higher rates of AWS, while affording universal AWS prophylaxis demonstrated improved outcomes. After controlling for MELD score and age, AWS was associated with increased risk of in-hospital infection, altered mental status, ICU admission, and requiring mechanical ventilation. These findings highlight the increased burden of AWS on patients with AH.

Framing harm reduction as part of an integrated approach to reduce drug overdose: A randomized message testing experiment in a nationally representative sample of U.S. adults, 2022

International Journal of Drug Policy

This nine-group randomized experiment (N=3,181) embedded in a national survey of U.S. adults tested how factual and narrative messages describing programs integrating harm reduction, addiction treatment, and/or other services to reduce overdose influenced respondents’ attitudes about harm reduction, relative to a comparison message defining harm reduction. 54.4% of respondents reported that an integrated approach including harm reduction, addiction treatment, and other services is effective at reducing overdose, compared to 63.6%-69.1% of respondents viewing messages describing integrated programs. Messages depicting either standalone harm reduction or integrated programs lowered respondents’ willingness to have a harm reduction program in their neighborhood, particularly when the messages depicted a Black person, versus a White person, benefiting from harm reduction.

DEA

Perceived threat and fear responses to e-cigarette warning label messages: Results from 16 focus groups with U.S. youth and adults 🔓

PLOS One

Currently e-cigarettes are only required to have warnings about addiction, but this study evaluated response to a range of warnings to inform future policy. The study evaluated response in adults and youths to 5 categories of warnings: toxic ingredients, health effects, cognitive development, addiction, and unknown risk. Researchers found that adults and youth had a danger control response, indicating one is more likely to avoid the behavior, to all categories except addiction. However, youth were more skeptical of the harms of e-cigarettes and display fear control, indicating one is less likely to avoid the behavior. The authors note that warning labels about negative health outcomes may make adult cigarette smokers less likely to switch to e-cigarettes as harm reduction and be less effective in getting youth to avoid e-cigarettes.

Learn More

Trends in Characteristics of Prescription Opioid-related Poisonings among Older Adults in the United States, 2015–2021

Journal of Addiction Medicine

In the context of the opioid epidemic, the authors examine trends in opioid poisoning in adults 60 and older between 2015 and 2021. Overall and among those 60-69, the number of opioid poisonings decreased, but opioid poisonings increased among those 70-79. The proportion of cases involving hydrocodone, hydromorphone, and morphine decreased, while the proportion involving buprenorphine increased. The study did find an increase in co-use of stimulants and gabapentin, while benzodiazepine co-use decreased. Lastly, the proportion of poisonings with major medical outcomes increased. The authors note that buprenorphine for opioid use disorder should continue, but careful monitoring may be indicated in the older population.

Characteristics Associated With Cannabis Use Initiation by Late Childhood and Early Adolescence in the Adolescent Brain Cognitive Development (ABCD) Study

JAMA Pediatrics

Using data from the ABCD (Adolescent Brain Cognitive Development) study, this research letter identified characteristics linked to early cannabis initiation. The biggest risk identified was prenatal cannabis exposure independent of use of other substances, or a family history of drug or alcohol problems. At one-year follow up, factors such as ease of obtaining cannabis, number of friends using, and greater peer tolerance were associated with increased odds of early initiation. In addition, anhedonia and depressed mood in preadolescents (9 to 11 years) were associated with future adolescent cannabis use. These findings suggest greater caution in attitudes, access, and use during periods of susceptibility, such as pregnancy, particularly for youth with other mental health disorders.

E-cigarette Unit Sales by Product and Flavor Type, and Top-Selling Brands, United States, 2020–2022 🔓

Morbidity and Mortality Weekly Report

This CDC Morbidity and Mortality Weekly Report discusses data on e-cigarette sales during the period 2020 and 2022. Total sales increased by 47% with sales of prefilled cartridges decreasing from 75 to 48% while sales of disposable e-cigarettes increased from 25 to 52%. In January 2020, the FDA announced the intent to restrict sales of flavored e-cigarettes due their appeal to youth. Although flavors decreased in prefilled cartridges, by the end of 2022, 80% of disposable cigarettes contained flavors other than tobacco, menthol, and mint. Flavored, disposable e-cigarettes are the most common type used by middle and high school students. This report recommends “comprehensive restrictions on the sale of all flavored tobacco products … in all jurisdictions.”

No time to lose: the current state of research in rapid-acting psychotherapeutics

Neuropsychopharmacology

Most medications for psychiatric and substance use disorders take weeks to be effective. However, some new treatments are rapid-acting. For example, ketamine can relieve symptoms of depression in hours. Rapid-acting treatments could significantly reduce morbidity and mortality. This article reviews recent research on a variety of treatments that are promising. Among them are psychedelics, the neurosteroid hormone brexanolone, immunotherapy with vaccines, deep brain stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, low energy focused ultrasound to brain nuclei, and brain neuropeptides (ghrelin, oxytocin). Many questions remain, such as mechanisms of action, and how long the therapeutic effects last; however, many therapies show promise.