American Society of Addiciton Medicine

The ASAM Weekly for April 16th, 2024

by ASAM Weekly Editors

This Week in the ASAM Weekly

Individuals with lived experience are shaping the field of addiction medicine for the better. A narrative analysis of the TV series Dopesick applies framing theory to understand how complex problems can be presented within the confines of narrative arcs and market forces, ultimately with a goal of bringing audiences and experts closer together in understanding (Plos ONE).

Similarly, a narrative evaluation of an online forum “Ganja Mamas” explores how (and why) pregnant people seek out support and advice from online peers about prenatal cannabis use (Journal of Studies on Alcohol and Drugs). Although the scientific evidence around prenatal substance use is concerning (Drug and Alcohol Dependence) and not always accepted by the public, the best remedy for medical misinformation is to keep the conversation open and ongoing (The Guardian). 

Additional opportunities for improvement are found in being receptive to a diversity of individual experiences. An appreciation for the role of trauma, guilt, and shame in women with opioid use disorder (OUD) has the potential to improve not only the women’s lives but that of their children and families (Journal of Substance Use and Addiction Treatment). Rural Americans face barriers to OUD treatment across all levels of the social-ecological model (Social Science and Medicine) and while mandated treatment might work for some, the experience for people of color is often one of coercion and punishment (NPR).

To borrow from a well-known medical quote-turned-adage: when you listen to individuals with lived experience, they will tell you a story -- one that identifies a problem, suggests solutions, and even teaches us something about ourselves.

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

Telling the story of the opioid crisis: A narrative analysis of the TV series Dopesick🔓

PLOS One

Dopesick (2021) is the first TV series with a plot that deals exclusively with the opioid crisis in the United States. The current study uses narrative analysis and framing theory to explore this series, discussing its portrayal of the people and themes involved in the opioid crisis. This analysis found that although Dopesick attempts to portray multiple dimensions of the opioid crisis, its narrative oversimplifies the story in attributing the cause of the problem almost exclusively to Purdue Pharma and its director Richard Sackler, while downplaying other factors that contributed to the opioid crisis. Thus, the narrative in this TV series tends to offer simple explanations to a complex problem for which simple solutions are likely to be inadequate. 

 

Feedback Needed

The American Medical Informatics Association (AMIA) 25x5 Task Force is conducting a two-minute, online survey to capture perceptions of excessive documentation burden from health professionals across all healthcare disciplines. The survey is open from April 10-26.

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Research and Science

Public Health Interventions and Overdose-Related Outcomes Among Persons With Opioid Use Disorder 🔓

JAMA Network Open

In this study researchers utilized a simulation model to estimate changes in opioid use disorder (OUD) prevalence and overdoses by varying public health interventions, including medication for OUD (MOUD) initiation rates. In the model, increasing availability of harm reduction strategies such as naloxone could decrease fatal overdose rates by 37%, with greatest impact among persons not receiving MOUD. Increasing MOUD initiation rates decreased OUD recurrence and prevalence. Based on the simulations, the authors support expanding interventions to reduce overdose in the short-term for greatest impact on fatal overdose and expanding MOUD initiation for greatest long-term impact. 

Evaluation of three-year neurodevelopmental outcomes in infants prenatally exposed to substance use

Drug and Alcohol Dependence

This prospective case control study examined associations between substance use during pregnancy and infant cognitive, motor, and language neurodevelopment at 3 years of age. Subjects were recruited from infants admitted to neonatal care units. Substance-exposed infants (n=32) were compared to non-exposed matched controls (n=32). Normal development was observed in 72% of infants exposed to any substance compared with 91% of non-exposed infants. Infants exposed to any substance had lower scores in all domains: cognitive (p=0.022), language (p=0.044), and motor (p=0.012). Infants exposed to cannabis had lower cognitive (p=0.007) and motor scores (p=0.012). Limitations include small sample size, and that tobacco use was more common among mothers of substance-exposed infants so that some of the results could be due to prenatal tobacco exposure.

Barriers to opioid use disorder treatment among people who use drugs in the rural United States: A qualitative, multi-site study

Social Science and Medicine

In this qualitative study, the authors evaluated barriers to opioid use disorder (OUD) treatment in rural areas. They found barriers both like those in urban settings and unique to the rural setting. Among the unique barriers were access, specifically the need to travel long distances to access treatment, and local pharmacies not dispensing buprenorphine. They also noted that the tight knit rural networks cause the following two concerns: (1) the inability to maintain privacy if getting treatment and (2) difficulty avoiding triggers for recurrence. Some of the other barriers included concerns about paying for treatment, maintaining employment if going to treatment, stigma, and long waitlists to enter treatment. 

The lived experiences and treatment needs of women with opioid use disorder and posttraumatic stress symptoms: A mixed methods study 🔓

Journal of Substance Use and Addiction Treatment

In order to better understand the needs of women with opioid use disorder (OUD) and posttraumatic stress disorder (PTSD), the authors interviewed women with both diagnoses and providers treating them. Among the themes identified were the use of opioids to numb emotional and physical pain and to assist in daily functioning, as the women often fulfilled a caregiver role. Respondents also expressed feeling stuck in a cycle of trauma and opioid use, with trauma leading to subsequent use and use leading to additional trauma. Feelings of guilt and shame were also frequently reported. The need for integrated trauma-focused treatment for OUD was also expressed by both providers and patients. The team plans to incorporate findings from this study into their integrated treatment program. 

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Better Together: Advancing Tobacco Use Treatment and Lung Cancer Screening 🔓

Journal of Thoracic Oncology

Lung cancer screening is now recommended for patients who have at least 20 pack-years of smoking and who have smoked during the past 15 years. Medicare requires that the screening include smoking cessation counseling. Several studies have shown this counseling has disappointing results. This editorial discusses a new study that adds print and videos concerning the benefits of smoking cessation, and feedback such as lung function and exhaled carbon monoxide to demonstrate positive effects. Unfortunately, these enhancements failed to improve outcomes. The authors call for more research aimed at improving smoking cessation in lung cancer screening. They also call for increased awareness of lung cancer screening, noting that only 4.5% of eligible patients received screening in 2023.

Disparities in Overdose Deaths: Looking Back at Larochelle and Colleagues’ 2021 Paper 

American Journal of Public Health

The Healing Community Study (HCS) aimed to show that implementation of a battery of evidence-based interventions to expand (1) access to naloxone, (2) the number of patients treated with medications for opioid use disorder (OUD), and (3) safer opioid prescribing practices would result in a 40% reduction of overdose deaths. The article by Larochelle et al is based on the baseline data from the four states that were part of the HCS. Larochelle et al corroborated and brought attention to the marked increases in overdose mortality among Black individuals, which continued to contribute to the unprecedented rise in overdose mortality in the subsequent years. The call by Larochelle et al for targeted interventions to support Black communities was prescient and is as crucial now as it was then if we want to eliminate health inequities and successfully address the overdose crisis. 

A Descriptive Analysis of a Popular Pregnancy Forum: Comments on the Developmental Consequences of Cannabis Use on Offspring

Journal of Studies on Alcohol and Drugs

This study characterized perceptions of the developmental impact of perinatal cannabis use (PCU) on children via a narrative evaluation of a public forum on which people discuss a range of issues around cannabis use. Posters (a) discussed the negative and positive impact of PCU on child physical, cognitive, and socioemotional development; (b) garnered information about PCU from sources other than medical providers; and (c) discussed harm-reduction approaches to reduce impacts of PCU on child health. There is a need for stigma-free support around PCU decision-making for people who select into discussion forums designed for communication and support around parental cannabis use. This forum presents a fruitful opportunity for intervention to encourage health-promoting behaviors through the provision of evidence-based information.