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

Aug 9, 2021, 13:40 by admin admin

Referred to as “the Army disease” in the late 19th century, addiction to opium derivatives including morphine allegedly involved as many as 400,000 Civil War combatants. As this estimate derives mostly from Federal disability pension records and the rolls of early veterans’ associations such as the Grand Army of the Republic, it is bound to have excluded survivors of the Confederacy. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

The tail-end-Charley item in this week’s ASAM Weekly is arguably the most practicable and promising of recent approaches to stimulant addiction, pharmacological or behavioral. The New York Times review of Contingency Management (CM)’s premises, benefits, and obstacles to implementation gives an accurate description for all levels of understanding. Steve Shoptaw and colleagues have demonstrated the concept’s efficacy repeatedly since the early 2000s - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

Below, Jim Wahlberg (older brother to the Calvin Klein underwear idol, ”Don’t call me Marky!” Wahlberg), describes his and his son’s experiences of addiction and of recovery. In reading it, I was drawn to parallels between his arguably more-famous brother and those on either side of the national debate on “rights”: The more junior Wahlberg has himself gone through changes, evolutions in opinion and commitments, in the days since he led a boy band. People’s views may soften with education, experience, and development of character; and sometimes we discover that it is our views which want softening. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

My mother, who was Australian, found Americans intriguing yet illogical, and strangely misdirected in their sentimentality. She explored this experience by marrying my father in the middle of a world war, so you could not accuse her of lacking a spirit of adventure or of inability to tolerate ambiguity. But she never could quite come to grips with one consequence of American commercialism. “Why,” she would ask, “is there a Mother’s Day in this country. Yet, a national pickle month?” Much of the time I would fall back on my role as callow adolescent, or cynical young adult, and shrug my shoulders, or encourage her to worry about something more important, such as whether Nixon was going to be elected. The seeming lack of honor accorded mothers by yielding an entire month to bottled vegetables was never quite resolved in her lifetime. Despite this, she went ahead and became a naturalized U.S. citizen in 1970. I thought I finally had the answer for her, when, in 2001, the status of pickles appeared to have been downgraded to a National Pickle Day (November 14, in case you are interested: https://nationaltoday.com/national-pickle-day/ ). I was wrong. She was no slouch at research, and I was reminded that she had been a secretary in the Ministry of Defense when my father, on leave from New Guinea, first won her attention. She pointed out to me that the pickle had yielded nothing in this virtual combat for primacy, as there is still a national pickle month as well as, now, a day. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

The ASAM Board of Directors met over the weekend preceding this issue of ASAM Weekly. It is a quarterly convocation, at one time a two-day affair: more recently one day event via virtual platform. The members of the Board are all unpaid volunteers, for whom travel and rooming is always at their own expense. These past, recent meetings have necessarily been hosted by a flow of electrons, and consequently blissfully economic. Because the Directors are all volunteers, and the Board meetings are only a fragment of their volunteer duties with ASAM, the spirit of collegiality was unusually strong. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

I frequently begin my talks by forewarning the audience that I do not know what is going to come out of this box up on my neck. It is a reflection on computers and on our limited control of their moment-to-moment functionality. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM

Aug 9, 2021, 13:40 by admin admin

I joined a recovery meeting last night, in itself no great surprise. But two revelations were provided to me, perhaps one more significant than the other. The more mundane one was that I found myself hearing old familiar friends clearly for once, in years. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM