This Week in the ASAM Weekly
Attention to xylazine is coalescing because of the combined harms that come with fentanyl. A new study in rats shows how the alpha-2 agonist may contribute to opioid deaths by eliminating a compensatory mechanism for opioid-induced brain hypoxia, leading to a stronger and more prolonged hypoxic state (Psychopharmacology). How this works in humans is important as the rate of xylazine detected in fentanyl-involved overdose deaths jumped 276% in recent years (MMWR) with men accounting for the majority (73%) of all xylazine-detected overdose deaths (NVSS).
The clinical images of xylazine-associated skin injury speak volumes and have caught national attention (NEJM). Delaware is piloting a single test strip that detects xylazine and fentanyl adulterants to protect against unintentional use (Philadelphia Inquirer) but intentional use is also a concern. More broadly, the discussion around harm reduction and decriminalization involves tensions between human rights, social norms, and treatment funding. Portugal’s experience exemplifies this fragile balance (Washington Post).
All this encourages us to recognize the significance of implementation- equally if it is driven by popular sentiment or scientific consensus. For example, the world’s first placebo-controlled trial of opioids in acute lowback and neck pain has confirmed what we’ve learned in hindsight -- that opioids should not be recommended in such situations (The Lancet). Researchers also hypothesized that medical cannabis laws would lead to a reduction in opioid prescribing, but it does not appear to have panned out that way (Annals of Internal Medicine). With such lessons-learned, many will be paying attention to Australia as it becomes a first in implementing treatments with psilocybin and MDMA (Nature).
While we have your attention, we’d like to share some important news from ASAM:
The Journal of Addiction Medicine continues to lead with yet another jump in its impact factor (5.5).
Experts in adolescent addiction are encouraged to apply to serve on writing committees for the 4th Edition of The ASAM Criteria®, Adolescent Volume.
ASAM reiterates its commitment to advancing access to high-quality addiction care (see below).
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