American Society of Addiciton Medicine

ASAM Weekly for August 22nd, 2023

by ASAM Weekly Editors

This Week in the ASAM Weekly

Managing influences is part of addiction. The public did a great job responding to anti-smoking messaging of past years but seems to be warming its perceptions around daily cannabis use and secondhand smoke (JAMA Network Open). Pretending not to market nicotine to youth never went out of fashion but efficiencies in technology re-invented the opportunity to bring us “office” highlighters for adults who wish to be discreet (Yahoo News/USA Today). Marketing ketamine for unspecified medical reasons raises concerns about the influence of Facebook ads -- something that has become less of a concern with print magazines (Washington Post). 

But influences come in all shapes and sizes. Normative social influence may explain the link between adolescents who experience cyberbullying and have a higher risk for initiating substance use (Drug and Alcohol Dependence). Gastric bypass seems to increase the risk for non-alcohol substance use disorders because somehow a surgery targeting obesity changes how the brain processes reward, thereby influencing substance use (Obesity). Motivating behavioral change gets at the heart of therapeutic interventions but involves complex brain processes, which may now be visible in patterns of resting state functional connectivity (Alcohol Clinical and Experimental Research). 

There are many ways we influence the brain and it influences us. To learn more, visit NIAAA’s virtual reality tour of the brain. 

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 

Perceptions of Safety of Daily Cannabis vs Tobacco Smoking and Secondhand Smoke Exposure, 2017-2021 🔓

JAMA Network Open

This study investigated perceived safety of cannabis vs. tobacco from 2017-2021 via daily smoking or secondhand exposure. The study found a significant shift in beliefs about the safety of daily smoking of cannabis vs. tobacco, with more than one-third reporting cannabis was safer than tobacco, and these numbers increased over time. Results were similar regarding secondhand cannabis smoke, with over 40% reporting it safer than secondhand tobacco smoke. Younger people and those who were unmarried were more likely to view cannabis as safer. A public health and regulatory response is therefore imperative to inform people of the known health risks associated with both daily cannabis smoking as well as secondhand exposure.

 

Research and Science

Resting state functional connectivity as a predictor of brief intervention response in adults with alcohol use disorder: A preliminary study 🔓

Alcohol Clinical and Experimental Research

Resting state functional connectivity (rsFC) may characterize neurobiological indicators that predict the response to brief interventions for alcohol use disorder (AUD). Researchers performed a resting state functional magnetic resonance imaging (fMRI) scan immediately followed by a brief intervention aimed at reducing alcohol consumption. Positive clinical response was defined as a reduction in alcohol consumption by at least one World Health Organization (WHO) risk drinking level at a 3-month follow-up. At baseline, responders had greater rsFC between specific seed regions in relation to voxel-based clusters than non-responders. Resting state functional connectivity in the frontoparietal, salience, and reward networks predicts the response to a brief intervention in individuals with AUD and could reflect greater receptivity or motivation for behavior change.

Association of Cyberbullying Victimization and Substance Initiation: The Adolescent Brain Cognitive Development (ABCD) Study

Drug and Alcohol Dependence

This study investigated whether cyberbullying is associated with substance use. Participants (N=1,335), aged between 10 and 14 years, were recruited from the Adolescent Brain Cognitive Development study. They were asked if they had ever been cyberbullied -- defined as someone trying to harm or be mean to them online, in texts, or on social media. They also completed a substance use survey. Both were repeated one year later. Cyberbullying was reported by 10%, alcohol use by 10%, and 0.2% reported marijuana use. Cyberbullying was significantly associated with substance initiation (OR=2.2 95% CI 1.7-2.8). The longitudinal data showed that cyberbullying was significantly associated with new initiation of substance use during the following year (OR=1.5 95% CI 1.03-2.18). The authors conclude that pediatricians should consider substance use preventive measures for those reporting cyberbullying.

Non-alcohol substance use disorder after bariatric surgery in the prospective, controlled Swedish Obese Subjects study 🔓

Obesity

Evidence that gastric bypass is associated with an increase in incidence of alcohol use disorder exists, but this study evaluates association between bariatric surgery and non-alcohol substance use disorders (SUD). Persons who underwent gastric bypass, vertical banded gastroplasty, or gastric banding were compared to those who received standard non-surgical treatment for obesity. In multivariate analysis, researchers found a significant association between gastric bypass and non-alcohol SUD (HR = 2.54, p-value=0.02). They did not find a significant difference for the other surgical interventions compared to the control group. The mechanism for increasing SUD is unclear and needs further research, but the authors suggest patients undergoing surgical intervention for obesity should be assessed for risk of SUD pre- and post-operation. 

REMS course

Fatal Drug Overdose Risks of Health Care Workers in the United States

Annals of Internal Medicine

This study used the 2008 American Community Survey (a Census bureau survey of 1% of US households) to study 176,000 health care workers and compare them to 1,662,000 non-health care workers. Drug overdose deaths were counted for these groups during the following 10 years. Annual overdose death rates were lowest for physicians (2.3 deaths/100,000) and highest for social or behavioral health workers (16 deaths/100,000). Compared to non-health care workers, the odds ratio for overdose deaths for health care worker groups was: Physicians 0.61, RNs 2.22*, health technicians 1.13, support workers 1.60*, and social/behavioral health workers 2.55* (*=p<0.05). These results were corrected for the influence of sociodemographic factors including gender, education level, and income. Social/behavioral health workers, RNs, and support workers are all at increased risk of overdose deaths.

Learn More

GDNF gene therapy for alcohol use disorder in male non-human primates

Nature Medicine

Alcohol use disorder is a lifelong disease often characterized by episodes of abstinence and relapses with limited therapies that target the underlying brain circuitry involved. In this study, the authors target the neuroadaptations of dysfunction of reward circuitry that occur in the ventral tegmental area (VTA). Human glial-derived neurotrophic factor (hGDNF) enhances dopaminergic neuron function, and the authors conducted gene therapy delivering a vector carrying the gene into the VTA of rhesus monkeys who had previously had chronic alcohol self-administration. The treated monkeys demonstrated increases in GDNF protein and dopamine, as well as significant decreases in alcohol intake sustained for up to a year. While additional research is needed, this study demonstrates GDNF as a potential target for treatment of alcohol use disorder. 

Buprenorphine Out-of-Pocket Costs and Discontinuation in Privately Insured Adults With Opioid Use Disorder

JAMA Internal Medicine

This study considered the link between out-of-pocket costs for an initial buprenorphine prescription and buprenorphine discontinuation within a 1-year period among commercially insured U.S. adults. Higher daily medication out-of-pocket costs were associated with treatment discontinuation. Generic film and tablet, as well as branded (Suboxone) tablets, also increased risk of discontinuation compared with branded film. Median time to treatment discontinuation was 64 days. The addition of buprenorphine to the Patient Protection and Affordable Care Act’s preventive drug list is but one consideration to ease the impact of the OUD crisis.

Prospects for Pain 🔓

The New England Journal of Medicine

This is a summary of an interview with the lead author and details from the accompanying article and editorial. Some types of pain have proven resistant to all available medications. New sodium-channel blockers offer promise for efficacious treatment. The NaV1.8 voltage-gated sodium channel, expressed in peripheral nociceptive neurons, plays a role in transmitting nociceptive signals. The effect of VX-548, an oral, highly selective inhibitor of NaV1.8, on control of acute pain is being studied. As compared with placebo, VX-548 at the highest dose, but not at lower doses, reduced acute pain over a period of 48 hours after abdominoplasty or bunionectomy. VX-548 was associated with adverse events that were mild to moderate in severity. This clinical study in humans shows that targeting a peripheral sodium channel can reduce pain in human subjects without significant adverse side effects.