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The ASAM Weekly for May 7th, 2024

by ASAM Weekly Editors

This Week in the ASAM Weekly

Substance Use Prevention – A Comprehensive Approach to Meet the Moment

Christopher M. Jones, PharmD, DrPH, MPH
Christopher M. Jones, PharmD, DrPH, MPH, is a Captain in the U.S. Public Health Service and currently serves as Director of the Center for Substance Abuse Prevention at the Substance Abuse and Mental Health Services Administration (SAMHSA).

The United States is in the midst of an evolving and dynamic overdose crisis, driven by the proliferation of fake pills that contain illicitly made fentanyl and other synthetic opioids. Recently released data from the Centers for Disease Control and Prevention (CDC) show more than 107,000 lives lost to overdose in 2022 – the largest number of deaths reported to date. CDC also published data estimating the number of lives lost due to excessive alcohol use – nearly 178,000 each year – an often-overlooked dimension of our nation’s substance use challenges.

Beyond the mortality statistics, we know millions more are struggling with substance use every day. SAMHSA’s latest National Survey on Drug Use and Health shows that among people 12 years or older, 78.3 million reported tobacco product or nicotine vaping in the past year, 70.3 million reported illicit drug use or prescription drug misuse in the past year, 61.2 million reported binge drinking in the past month, and 48.7 million had a past-year substance use disorder.

The reality is that substance use has never been riskier, whether it is someone who is engaging in initial use or someone with a long-standing substance use disorder. The risk of overdose and other harms is now elevated with any use of an illicit drug, given the potency, lethality, and unpredictability of fentanyl (and other additives such as xylazine) in the illicit drug supply. Importantly, these substance use challenges are happening against the backdrop of rising mental health challenges, especially among young people, that are closely linked to substance use and overdose.

These dynamic and interrelated challenges mean that we have to approach our substance use prevention work in new and innovative ways — addressing the acute urgency of rising overdose deaths and other substance use-related harms, while remaining laser-focused on addressing the root drivers of substance use at the individual, family, school, community, and society levels. That is why SAMHSA included preventing substance use and overdose as a key pillar of its Strategic Plan.

Read the full editorial.

ASAM Clinical Considerations for Engagement and Retention of Non-Abstinent Patients in Substance Use Treatment

Beginning today through June 3rd, ASAM has made available for public comment a draft of its Clinical Considerations for Engagement and Retention of Non-Abstinent Patients in Substance Use Treatment document. 

Click Here for More Information

Lead Story

Biomarkers of metal exposure in adolescent e-cigarette users: correlations with vaping frequency and flavouring ðŸ”“

Tobacco Control

Various metals have been identified in e-cigarettes and, as their use among youth has increased in the last decade, this is of public health concern. In this study, researchers utilized a national sample of youth who use e-cigarettes and associated between lead, cadmium, and uranium levels and use patterns. Youth who reported intermittent or frequent use had higher levels of lead than occasional users, and frequent users also had higher levels of uranium. In addition, when evaluating by flavor types, sweet flavor e-cigarette use was associated with higher uranium levels than menthol/mint flavors. Given the potential deleterious health effects of these metals, particularly in youth, these findings support the need for regulations and public health interventions to target youth populations and minimize e-cigarette use.

Something From ASAM's Partners...

Register for the Connecting Kids to Coverage National Campaign’s mental health webinar, “Medicaid and CHIP Behavioral Health Services: Impact of School-Based Mental Health Care,” on Wednesday, May 8 at 3:00 p.m. ET to learn how schools play a critical role in providing mental and behavior health care and referrals to students. 

Register Today

Research and Science

Age differences in patterns of cannabis use among an online US sample of adults who consume cannabis frequently

The American Journal of Drug and Alcohol Abuse

A survey about patterns of cannabis use was completed by 4,151 adults recruited through Facebook/Instagram. Respondents were selected if they had used cannabis in the past 7 days, and 82% were daily cannabis users. Older adults (>50yr) were more likely to consume cannabis by a single method, primarily smoking, than younger (18-49yr) users, among whom vaping was also common. Younger users were more likely than older users to use concentrates (by vaping or dabbing) with very high levels of THC. Researchers conclude that use of highly potent concentrates increases risks of cannabis use in younger adults. Older adults face increased risk from smoking-related health consequences.

Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus ðŸ”“

JAMA Network Open

This cohort study examined whether the Comprehensive Primary Care Plus (CPC+) demonstration was associated with improved access to mental health and substance use services. It included 188,770 adults with anxiety, depression, or opioid use disorder (OUD), and the findings were mixed. Individuals with OUD who received care at CPC+ practices filled more buprenorphine and anxiolytic prescriptions than those receiving care at non-CPC+ practices. The study suggests that integration of behavioral health in primary care may improve access to mental health and substance use treatment, especially for individuals with OUD.

ASAM PAM 7

ASAM Clinical Algorithm Subcommittee

As a part of ASAM’s mission to define and promote evidence-based best practices in addiction prevention, treatment, remission, and recovery, the ASAM Clinical Algorithm Subcommittee will collaborate with ASAM staff in refining the 4th Edition clinical algorithms for ASAM Criteria based assessment tools. 

Apply Here

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Advances in animal models of prenatal opioid exposure ðŸ”“

Trends in Neurosciences

Neonatal opioid withdrawal syndrome (NOWS) is of growing concern in the opioid epidemic, and while short-term effects of opioid withdrawal are generally understood, the long-term consequences are still unclear. In this paper, the authors review the various preclinical animal models used to evaluate developmental, molecular, and behavioral impacts of pre and perinatal opioid exposure. The models they describe include morphine, oxycodone, synthetic opioids, and medications for opioid use disorder. Across the models there are sometimes inconsistent outcomes. One significant gap the authors noted is that no models include polysubstance use, either with various opioids or other psychoactive substances. The variety of preclinical models offer benefits to understanding the array of clinical outcomes from prenatal opioid exposure, but more research is needed. 

Buprenorphine Dispensing after Elimination of the Waiver Requirement

The New England Journal of Medicine

This study compared retail prescriptions for buprenorphine during the year before and the year after the “X waiver” was eliminated in January 2023. During 2022, the number of prescribers of buprenorphine increased from 38,684 to 42,158. During 2023, post waiver, the number of prescribers increased at a greater rate to 53,635 at the end of the year. However, the number of patients receiving buprenorphine changed little during 2022, and that pattern continued in 2023, showing little effect of the waiver elimination. The number of patients initiating buprenorphine treatment decreased during 2022 from 51,652 to 46,565. In January 2023, an additional 5,245 patients initiated buprenorphine; however, the number of new patients continued to decline during the rest of 2023 at a rate similar to 2022. The authors conclude that elimination of the waiver did not meaningfully increase buprenorphine use.

Post-Dobbs Challenges in Research and Patient Protections

JAMA Psychiatry

Abortion restrictions create unique barriers for the conduct of substance use research. While substance use clinical research faces distinctive challenges, several concerns generalize to clinical research for other psychiatric disorders. For example, lack of privacy protections for reproductive health information in clinical research may add to recruitment obstacles due to participant concerns about legal exposure if they become pregnant or experience pregnancy loss or termination. Investigators may also have concerns about the possible liability of such regulations and ultimately conclude that it is too risky to conduct research with women and other people who are pregnant. Abortion restrictions mean pregnant people could again be designated as vulnerable in that they cannot always make their own health choices or access health care they deem necessary. The vulnerability designation increases barriers to pregnant people participating in clinical trials.