Aug 9, 2021, 13:40 by admin admin

For ASAM Weekly readers who are not themselves ASAM members, you are owed an update on the parent organization’s activities at this time of year. Over the course of one week, all committees, councils, officers, and members of the Board of Directors will transition, replacing and being replaced by elected and appointed members. The weekend following, ASAM holds its annual scientific conference. For most of us who are involved in instruction or regional continuing medical education, conferences tend to be stacked up at this time of year; in a shameless plug, the Hawaii Addictions Conference provides an example of how inexpensive and how increasingly well-wrought the online trainings can be [ https://blog.hawaii.edu/dop/hac-2021/ ]. All of this by way of reintroducing a solicitation for Assistant Editors, as education at all levels is a fundamental obligation of the Society. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

The article below cited in the journal Addiction examines the effectiveness of e-cigarettes for smoking cessation. Apart from underlining differences between American and British views of the marketing of medications and appliances, it underscores an important philosophic difference in the definition of the illness state. In the most recent American iteration of diagnostic language (DSM5), the addiction that involves nicotine is referred to as a tobacco use disorder. This has resulted in a particular focus on smokable (combustible) tobacco products as the agent of harm or as the basis for a description of the illness. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

The Washington Monthly item at the end of this week’s issue deserves some contemplation. The notion that our stress on addiction as a “… brain disease” may actually be counterproductive, is itself counterintuitive. And yet it is less so if you consider addiction to be the outcome of multiple forces and conditions. It is surely the case that increasingly effective medication aids in recovery; and equally, that recovery is more than a replenishment of some neurotransmitters, and inhibition of others. Yuval Noah Harari (Homo Deus, ch.3) would have us understand that cooperation is requisite to effect change in human behavior. So also would most who belong to community recovery programs, lead psychotherapy seminars, and the like. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

The readers may be best served this week with a renewed link to the 25 February 2021 policy on racial justice. My understanding of social movements is that they are most likely to be successful if 1) their adoption costs the opposition nothing tangible; 2) they are tied to a shared, positive experience (as in “marriage”); and 3) they are persistent, as the drumming of raindrops on a stone. Brevity helps; the linked document is all of 4 pages before the references, and its recommendations occupy only one page. Perhaps start with the “Recommendations”, please, and then you will feel your time best-respected. If you find the concepts and the reasoning are exportable to your own work or other professional setting, please cite freely. The greater the concord, the greater the momentum to long-delayed remedies. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

The world seems always to seek a newer agent that will bring us to a new level of pleasure, of joy. I have paraphrased Don Draper of Madmen before in his asking, "What is happiness? Happiness is the moment before you need more happiness.” The review article on cannabis (Journal of Psychopharmacology ) below brings the Senior Editor to mind of a previous initiative involving an alcohol substitute that was ostensibly hangover-free, "Alcosynth." The players may differ but the game’s objective stays the same: pleasure without consequences. Whether it is a "nonaddictive” opioid substitute, such as pentazocine (Talwin), meperidine (Demerol), or tramadol (Ultram); vaporized nicotine in place of tobacco fumigation (to supposedly evade damages resulting from tobacco smoke); benzos vs. barbs; or even synthetic sweeteners in that 32 oz. Big Gulp, the alchemists’ search for the hedonic Philosopher’s Stone never abates. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

Our medical school hosts a weekend curriculum for lay community members, many of whom are retired or have relatives working in medicine. It is spread across several months, and I was asked to speak last week about substance use in the elderly. After the event, I was thrown more than a dozen questions. My responses did not satisfy me in several instances, but you do what you can do when you're standing at a podium in front of 100 potential donors to the school. The show must go on. I don’t expect all in the readership to agree with my answers – after all, a good many of you are certainly smarter than I, or at least more cautious. Here are a few of the audience’s Q & A items: - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

Last week carried the hope of a real holiday, Presidents’ Day; or at least one for the Feds, with the possibility of a trickle-down effect. But by Wednesday, any elation experienced at the prospect of a four-day workweek had been blown either into the Gulf of Mexico or across the Great Lakes by a fierce and unrelenting winter assault. My words of sympathy to colleagues in virtual conferences or just on telephone calls most likely sounded taunting, even micro-aggressive. How could it not? With our own winter weather in Hawai`i dropping at night down to 69°, we’ve not a lot of justification for lamentation. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

The final selection below addresses the recent effort on the part of the Department of Health and Human Services to remove specific training requirements for the prescription of buprenorphine, for physicians. As most will be aware, that plan has been suspended subject to further review, but remains alive. The central focus of the article – actually an op-ed piece in The Hill - is on the distinction drawn between physicians and others with prescriptive authority (advanced practice registered nurses and physician assistants). The CARA act of 2016 requires both classes of providers to undergo training in addition to that normally required for obtaining or maintaining a DEA license for the prescription of controlled substances. Presently, the training requirement is significantly greater (3-fold) for non-physicians. The mandate was originally in recognition of the newer indication beyond analgesia for buprenorphine, for opioid use disorder. It was as well a concession to those who contended that, without some form of interpersonal therapy, the medication alone was inadequate. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

This week’s abstracts all made really good reading; fortunately so, as that will balance the notable absence of a thoughtful editorial. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

In reference to the AHRQ 91 January abstract, below: The jury remains out on the question of which toxins are culpable in injuries sustained by the developing fetus, among mothers who use tobacco products. Is it nicotine, carbon monoxide, any of the complex tars that comprise the smoke, etc.? There is an enduring reversion to the notion that cigarette smoking is the needed target of our efforts; yet in so doing, we sidestep the question of the toxicity of nicotine alone – and thus the risk of lozenges, vaping, gum, any of the delivery systems. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

For 26 January 2021, William Shakespeare’s 119th Sonnet is provided here. It is a meditation on obsession, describing an unfulfillable expectation of an alchemical conversion: the transmutation of evil thoughts and behaviors. You may take issue; but I believe it to be a poem about addiction. Being printed in the New York Times at least makes an article susceptible to commentary and criticism by the readership, even while not strictly meeting peer review standards. A discussion of drug usage by psychology professor Carl Hart is reviewed in the New York Times at this link, and is largely self-referential: https://www.nytimes.com/2021/01/12/books/review/drug-use-for-grown-ups-carl-l-hart.html Focusing principally on heroin use, Hart makes a case for mood-altering drugs as useful, pleasurable, and generally safe over time providing “…a gradual rejection of the overly simplistic idea that drugs are inherently evil, the destroyers of people and neighborhoods.” - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

“I discovered that the predominant effects produced by the drugs discussed in this book are positive,” Carl L. Hart writes in his new book. “It didn’t matter whether the drug in question was cannabis, cocaine, heroin, methamphetamine or psilocybin.” Being printed in the New York Times at least makes an article susceptible to commentary and criticism by the readership, even while not strictly meeting peer review standards. A discussion of drug usage by psychology professor Carl Hart is reviewed in the New York Times at this link, and is largely self-referential: https://www.nytimes.com/2021/01/12/books/review/drug-use-for-grown-ups-carl-l-hart.html Focusing principally on heroin use, Hart makes a case for mood-altering drugs as useful, pleasurable, and generally safe over time providing “…a gradual rejection of the overly simplistic idea that drugs are inherently evil, the destroyers of people and neighborhoods.” - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

We are accustomed to referring to excitement-seeking individuals as “adrenaline junkies”. It is a pithy characterization regardless of its accuracy, as it explains behaviors that may be innately destructive using a metaphor with which we are very familiar: compulsive and progressive use of the substance that alters a mood state, such that the individual becomes progressively reliant on it. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

From the movie “Lucy,” 2014, : “Time is the only true unit of measure. It gives proof to the existence of matter. “ So when folks are inclined to be sage and instruct me that New Year’s Day is simply a convention, a calendar heading that has yet to be filled with real data… I, in turn, think of how we mark the anniversaries of those whom we love, including of course their dates of birth and of death. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

We hope you, your loved ones, and everyone you know is safe and healthy this holiday season. 2020 has been a difficult year for so many and unfortunately a tragic year for too many. Hopefully, 2021 will bring some much needed joy into peoples’ lives. For now, we’d like to offer you this small tradition of joy with an end-of the-year editorial review in honor of the selfless work Bill has done over the years at the ASAM Weekly. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

If I really mean what I am about to write next, I will preface it with this: please read the four excellent pieces on ethanol and the commentary on stigma assembled below, before you bother with my editorial. If you then have time, maybe then come back to the editorial. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

On November 30, the American Board of Preventive Medicine (ABPM) and ASAM jointly announced the extension of eligibility for completion of Addiction Medicine board certification through the 2025 examination cycle, using the “Practice Pathway”. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

World AIDS Day coincides with the submission deadline for this weblog, December 1st. This is a rich territory to mine for parallels in both addiction and infectious disease epidemiologic patterns. I can only intimate the similarities in this short space, so recommend the following exercise: Below are three separate links, describing incidence respectively for HIV disease; opioid prescribing; and COVID-19 cases (both those in this past week and for comparison those in June of this year). ASAM Weekly is a digest, it is intended to abbreviate your immersion in available literature; so I suggest that you simply tap on those websites serially, very briefly, to get a sense of where these illnesses are striking most forcefully. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

A recurring theme among the responses to the Covid-19 pandemic has been reconstruction and “normalization,” specifically of the national economy. Folks who work in the field of addictions have ample experience with unstable environments, both the worldly one and the internal milieu. In the latter case, it is wiser to not have great and brittle expectations when helping someone deal with their addiction. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

My comment this week will be of interest only to ASAM members. I apologize; it is a narrowing of focus that I normally avoid. However, we are approaching the interval in which elections are opened for ASAM Officer and Directorship positions. And as we have been relentlessly taught in recent years, a democracy is only as good as its rate of participation. In fact, these Society elections have been notoriously under-attended by the membership - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM