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The ASAM Weekly for February 13, 2024

by ASAM Weekly Editors

This Week in the ASAM Weekly

As you may have noticed, we published several guest editorials recently and, over the next months, we intend to publish many more. Our goal is to provide readers with timely and accessible viewpoints from leaders in the field, covering a wide range of interesting topics. In addition to these efforts, we’ll continue to grow our podcast and search for new ways to bring you important addiction-related information.  

At The ASAM Weekly, we remain committed to being your reliable weekly newsletter, offering summaries of the salient research in the field. We would also love to hear your thoughts on how we can make it even more engaging.

Please take a few minutes to fill out our survey below. You could win a $100 ASAM eLearning Center gift card but most importantly, your input can help make the ASAM Weekly even better. We always appreciate the feedback.  

2024 ASAM Weekly Reader Survey

One last thing -- we’re thinking about identifying more publications that come with CME opportunities. For example, there’s a thoroughly informative and concise commentary from the Journal of Addiction Medicine about the harms pregnant and postpartum people face because of structural and interpersonal bias. It’s not only a CME opportunity, but also an Editor’s Choice publication.

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM, Jack Woodside, MD, John A. Fromson, MD

Lead Story 

Safety of e-cigarettes and nicotine patches as stop-smoking aids in pregnancy: Secondary analysis of the Pregnancy Trial of E-cigarettes and Patches (PREP) randomized controlled trial 🔓

Addiction

It is not clear to what extent nicotine is responsible for adverse outcomes of smoking during pregnancy. This study examined outcomes of e-cigarette (EC) and nicotine replacement therapy (NRT) use in pregnancy. Pregnant smokers were randomly assigned to EC or NRT. ECs were more than twice as likely to be used regularly compared to NRT. Those abstaining from cigarettes had higher birth weights (3.3 Kg) than smokers (3.1 Kg), and the use of EC or NRT did not affect birth weight in abstainers. In the entire group (abstainers and smokers), use of EC and/or NRT was not associated with an increase in adverse events. Those using EC had less cough and phlegm than those using NRT. Other studies have confirmed the same, possibly resulting from antibacterial effects of additives to the EC liquid. The authors found no risks to pregnancy from EC or NRT use. 

Research and Science 

Associations of Menstrual Cycle and Progesterone-to-Estradiol Ratio With Alcohol Consumption in Alcohol Use Disorder: A Sex-Separated Multicenter Longitudinal Study

The American Journal of Psychiatry

This sex-separated multicenter longitudinal study analyzed 12-month data on real-life alcohol use (from 21,460 smartphone entries), menstrual cycle, and serum progesterone-to-estradiol ratios (from 667 blood samples at four individual study visits) in 74 naturally cycling females and 278 males with alcohol use disorder (AUD) between 2020 and 2022. Menstrual cycle phases were significantly associated with binge drinking and progesterone-to-estradiol ratio. In males, a higher progesterone-to-estradiol ratio was related to lower probabilities of binge drinking and any alcohol use.  Findings suggest that high progesterone-to-estradiol ratios can have a protective effect against problematic alcohol use in females and males with AUD, highlighting the progesterone-to-estradiol ratio as a promising treatment target. 

Buprenorphine misinformation and willingness to treat patients with opioid use disorder among primary care-aligned health care professionals 🔓

Addiction Science & Clinical Practice

Health care practitioners (n=409) in Ohio completed an email survey of beliefs and attitudes about buprenorphine and OUD. The misinformation about buprenorphine most endorsed (25%) was that it substituted one drug for another. Second (21%) was that buprenorphine is not effective in reducing overdoses. The number of items of misinformation endorsed was associated with less willingness to work with patients with OUD. Almost half of the respondents believed they had been adequately trained to treat OUD, which was associated with increased willingness to work with patients with OUD. Negative bias towards patients with OUD was associated with less willingness to work with patients with OUD. They conclude that misinformation about buprenorphine is common and education to address it is essential to increasing utilization of MOUD. 

Magnesium–ibogaine therapy in veterans with traumatic brain injuries 🔓

Nature Medicine

This is a prospective observational study of the Magnesium–Ibogaine: the Stanford Traumatic Injury to the CNS protocol (MISTIC), provided together with complementary treatment modalities, in 30 male Special Operations Forces veterans (SOVs) with predominantly mild TBI. Ibogaine is a plant-derived compound known to interact with multiple neurotransmitter systems that has been studied primarily as a treatment for substance use disorders. It has been associated with instances of fatal cardiac arrhythmia, but coadministration of magnesium may mitigate this concern. MISTIC resulted in significant improvements in functioning both immediately and 1 month after treatment and in PTSD, depression, and anxiety at 1 month after treatment. There were no unexpected or serious adverse events. 

Learn More

Self-fulfilling Prophecy: Does Structural and Interpersonal Bias Against Pregnant and Postpartum People With Substance Use Disorders Undermine Parenting Identity?

Journal of Addiction Medicine - CME/Editor’s Choice

This commentary discusses two qualitative studies in the Journal of Addiction Medicine concerning patients with SUD and their interaction with providers of prenatal care of the newborn. Overdose death has become the leading cause of maternal mortality in the US. Policies that require reporting of prenatal substance use, including OUD treatment medications, discourage patients from seeking prenatal care. One study reported that 50% of participants had lost custody of a prior child. Unlike usual postnatal care, providers were focused on monitoring infants for effects of substance exposure and the parents for signs of poor parenting. Parents are reluctant to ask for help, fearing being judged inadequate parents. This lack of trust results in the loss of normal parent experiences. In contrast, supportive clinicians who did not stigmatize participants enhanced the parenting experience. The author suggests that policies and practice be modified to enhance respectful care. 

Systemic Racism as a Determinant of Health Inequities for People With Substance Use Disorder

JAMA Psychiatry

In this opinion piece, the authors describe the role of structural factors, such as policies and practices, in health inequities and propose harm reduction as a tool to address the inequities. There are significant disparities and inequities in access to addiction treatment, notably differences in receipt of naloxone and buprenorphine. The authors support an antiracism framework using harm reduction strategies, recognizing ethnoracial traumas, practicing cultural humility in addiction research, and in developing and sustaining the addiction workforce. Particularly, they discuss the necessity of including racial and ethnic minority people in the development of policies and research.   

Causation and Common Liability in the Progression of the U.S. Opioid Crisis 🔓

Journal of Studies of Alcohol and Drugs

Nonmedical use of prescription opioids (NUPO) alone is highly unreliable in differentiating who will or will not go on to use illicit opioids. With increasing rates of illicit opioid initiation before NUPO and a small fraction of NUPO initiates ultimately using illicit opioids, one could not argue NUPO to be necessary or sufficient for illicit opioid initiation. Rather, NUPO is a single element in the myriad factors that combine to potentiate illicit opioid initiation. From this perspective, looking beyond NUPO to broader contextual risk factors, such as polysubstance use and mental health symptoms, is most crucial to mitigating risk for opioid-related harms. Such a common liability-oriented approach is consonant with recommendations that drug-nonspecific factors be addressed in prevention and treatment in lieu of exclusively focusing on the opioid-specific programming. 

Using latent class analysis to identify different clinical profiles according to food addiction symptoms in obesity with and without binge eating disorder 🔓

Journal of Behavioral Addictions

In this study, the authors conducted latent class analysis (LCA), a person-centered approach to identify distinct patient profiles, for food addiction (FA) symptoms among persons with obesity with and without binge eating disorder (BED). They identified 5 distinct classes; notably, class 4: “high-functioning addicted” and class 5: “fully addicted” had the preponderance of persons with BED and met criteria for “FA diagnosis.” However, “high-functioning addicted” patients demonstrated less of the impairment and distress criteria. The authors suggest the “high-functioning addicted” class may represent a prodromal category and high-risk group which should be targeted for interventions to potentially prevent progress to more severe negative outcomes.