American Society of Addiciton Medicine

The ASAM Weekly for June 18th, 2024

by ASAM Weekly Editors

This Week in the ASAM Weekly

The American Medical Association (AMA) recently voted to support eliminating criminal penalties for drug possession for personal use. Dr. Steven Taylor, on behalf of ASAM, offered an important point for critics to consider: decriminalization “can have public health benefits if it is done correctly [but] we would suggest that we have yet to see it done correctly" in the US (MedPage Today). 

The former surgeon general of the United States, Dr. Jerome Adams, called on Congress to act because “Black Americans suffering from substance use disorders need help”. He cites the disparities regarding drug-related incarcerations, overdose deaths, access to care, and stigma, while providing solutions like approving the Reentry Act and the Modernizing Opioid Treatment Access Act, increasing access to MOUD, and funding harm reduction programs (USA Today).

The LA Times Editorial Board stated, “L.A. has a serious meth problem, and it’s time to talk about it,” and acknowledged several reasons why discussing this issue can be more difficult than the current discourse on opioids (LA Times ). In another LA Times article, reporters described how the use of slang - a seemingly benign human behavior - can outwit technology and the authorities while enabling people to “easily get heroin delivered to [their] house in 20 minutes" (LA Times) Whatever could a tech company like Craigslist do to stop this?

In an opinion audio piece about Hunter Biden, Patti Davis concluded that there “are a lot of Hunter Bidens in this world…who long for someone to believe they can recover and construct their lives differently. You just don’t hear about them on the evening news” (New York Times). 

As highlighted by these pieces, oftentimes our responsibility is to motivate change in individuals without substance use disorders.

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

Invitation to Review: ASAM Draft Clinical Practice Guideline on Benzodiazepine Tapering

Beginning today through July 19th, the American Society of Addiction Medicine (ASAM) has made available for public comment a draft of its Clinical Practice Guideline on Benzodiazepine Tapering. For more information and instructions to review, please click here.


Lead Story

Piloting a Hospital-Based Rapid Methadone Initiation Protocol for Fentanyl 

Journal of Addiction Medicine

The epidemic of fentanyl has led to increased opioid tolerance and made traditional dosing for methadone initiation insufficient. In this study, the authors examined an inpatient rapid titration of methadone initiation among patients with opioid use disorder (OUD). The protocol recommended dosing of 60 mg on day 1, 70 mg day 2, 80 mg day 3 and 100 mg day 4-7. After patients with significant underlying medical conditions, benzodiazepine or alcohol use, and age >65 were excluded, 25 patients underwent the rapid initiation. No patients in the study experienced an adverse event and while additional research is needed, the study demonstrated the feasibility of rapid initiation of methadone for OUD in select patients in an inpatient setting. 


ASAM Clinical Algorithm Subcommittee
CALL FOR APPLICATIONS!

The ASAM Clinical Algorithm Subcommittee is looking for members to collaborate on refining the 4th Edition clinical algorithms for ASAM Criteria-based assessment tools! Click the link below to learn more and apply.

Applications Deadline Extension: June 30, 2024 



Research and Science

Evaluation of Strategies to Enhance Community-Based Naloxone Distribution Supported by an Opioid Settlement 🔓

JAMA Network Open

This study explored the potential impact of expanded naloxone distribution supported by an opioid settlement and how to enhance this impact by increasing witnessed overdoses. In this decision analytical model including a simulated population of Rhode Island residents at risk for opioid overdose, distributing more naloxone supported by the state’s opioid settlement was projected to reduce annual opioid overdose deaths (OODs) by up to 9% with an optimized distribution. The addition of a 60% increase in witnessed overdoses could further reduce annual OODs by 37%. Combining expanded naloxone distribution with efforts to increase witnessed overdoses could result in a greater reduction in OODs than when these 2 strategies are implemented separately.

Increases in drug-related infant mortality in the United States 🔓

Journal of Perinatal Medicine

In this study, the authors examined drug-involved infant deaths between 2018 and 2022. They found a significant 2.2-fold increase in drug-involved infant deaths in this 4 years period, accounting for 1.18% of all infant mortality. Deaths occurred primarily in the post-neonatal period, 28-364 days old, and were predominantly among non-Hispanic White infants (60.4%). These findings are concerning and require a broad public health intervention, including treatment for maternal substance use disorders, prenatal care access, and neonatal and post-neonatal care access.

Exposure to maternal cannabis use disorder and risk of autism spectrum disorder in offspring: A data linkage cohort study 🔓

Psychiatry Research

This study looked for an association between maternal cannabis use disorder (CUD) and diagnosis of autism spectrum disorder (ASD) in offspring. The data were obtained from administrative databases that cover all mother infant pairs in New South Wales Australia between 2003 and 2005 (n=259,150 births). Offspring were followed for a diagnosis of ASD through 2018. Researchers found that a maternal diagnosis of CUD during the prenatal period carried a threefold increased risk of ASD in the offspring (aRR=3.02). A similar risk was found for a maternal diagnosis of CUD in the year prior to conception (aRR = 3.13). The authors also found that the association of ASD with maternal CUD was greater in male than female offspring. They note that previous studies have shown mixed results; however, these past studies included small numbers and used cannabis exposure by self-report instead of an independent diagnosis of CUD.

Cannabis Use Reported by Patients Receiving Primary Care in a Large Health System 🔓

JAMA Network Open

This study examined the prevalence of past 3-month cannabis use and the reasons for use among patients in a large health system. In this cross-sectional study of 175,734 patients, 17.0% reported cannabis use, among whom 34.7% had results indicative of moderate to high risk for cannabis use disorder. While most patients (76.1%) reported using cannabis to manage a health symptom, very few patients identified as medical cannabis users. Given the high rates of cannabis use, especially for symptom management, and the high levels of disordered use, it is essential that health care systems implement routine screening of primary care patients.

ASAM PAM 7

CO*RE REMS/ASAM Striking a Balance: Podcast Series

This free series consists of three 45-minute podcasts designed to empower clinicians to confidently manage opioid analgesics, from patient assessment and therapy initiation to modification, discontinuation, and patient counseling.


Learn More

Functional connectivity changes in the brain of adolescents with internet addiction: A systematic literature review of imaging studies 🔓

PLOS Mental Health

Internet usage has seen a stark global rise over the last few decades, particularly among adolescents and young people, who have also been diagnosed increasingly with internet addiction (IA). IA impacts several neural networks that influence an adolescent’s behavior and development. This is a literature review on resting-state and task-based functional magnetic resonance imaging (fMRI) studies to inspect the consequences of IA on the functional connectivity (FC) in the adolescent brain and its subsequent effects on behavior and development. FC changes led to addictive behavior and tendencies in adolescents. The subsequent behavioral changes are associated with the mechanisms relating to the areas of cognitive control, reward valuation, motor coordination, and the developing adolescent brain.

IL17RB genetic variants are associated with acamprosate treatment response in patients with alcohol use disorder: A proteomics-informed genomics study 🔓

Brain, Behavior, and Immunity

There is significant variation in response to acamprosate treatment for alcohol use disorder (AUD); the authors utilized proteomics-informed genomics methods to identify genetic variants that may account for the difference in response. They found interleukin-17 receptor B (IL17RB) levels may be associated with acamprosate treatment outcomes. While other factors may influence IL17RB plasma levels, genetic variants in IL17RB may be important in first steps toward individualized treatment therapy for AUD. 

How an opioid giant deployed a playbook for moulding doctors’ minds 🔓

The BMJ

During the period 2006-2012, Mallinckrodt was the lead producer of prescription opioids (Purdue was number 3). During litigation for deceptive marketing, Mallinckrodt turned over 1.3 million internal documents. In this essay, the authors describe some of the company’s marketing practices. To counter physicians’ reluctance to prescribe opiates, Mallinckrodt designed a CME program that reached 88,316 prescribers by 2017, involving “key opinion leaders” to make content credible. One, Charles Argoff, editor of pain journals, received around $200,000 a year. In a 2010 book, he revived the idea that “[o] nly rarely does opioid medication cause a true addiction…”. Mallinkrodt created journal articles to promote their views and contracted with a company, MedLogix, that would “research, draft, revise, submit, and coordinate authorship.” In a 2013 email, a sales manager stated, “you have only 1 responsibility, SELL BABY SELL!”