Avsnitt
-
State-level racial and ethnic disparities in buprenorphine treatment duration in the United States
The American Journal on Addictions
National trends reveal a concerning escalation in racial and ethnic disparities in buprenorphine treatment duration for opioid use disorder. This study examined such disparities at the state level. Analyzing 9,040,620 buprenorphine prescriptions dispensed between January 2011 and December 2020 from IQVIA Longitudinal Prescription data, the study revealed substantial statewide variations in racial and ethnic disparities. Specifically, 21 states showed longer treatment durations for White people across all episodes, and 8 states displayed similar trends among episodes lasting ≥180 days. Longer treatment durations for White people in both overall and long-term episodes were exhibited in 5 states, and 15 states showed no racial and ethnic disparities.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Virtual reality-based Mindfulness-Oriented Recovery Enhancement (MORE-VR) as an adjunct to medications for opioid use disorder: a Phase 1 trial 🔓
Annals of Medicine
Mindfulness-Oriented Recovery Enhancement (MORE) uses mindfulness training to address dysregulation in brain reward systems. MORE has been shown to reduce drug cue reactivity and in an RCT reduced opioid misuse 45% at 9 months. Face-to-face MORE requires significant time of trained clinicians, and this study explored the feasibility of delivering MORE by virtual reality (VR). Treatment consisted of 8 weekly, one-hour MORE-VR sessions. Patients could choose the VR setting for their meditation (beach, forest, waterfall) and interact with virtual drugs and paraphernalia during session 5, which was devoted to examining and managing craving. Of 38 patients, 68% completed 4 or more sessions and 50% completed all sessions. Opioid use decreased significantly (p =.04), as well as craving (p<.001), and results showed a significant increase in positive affect (p<.001).
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Saknas det avsnitt?
-
The Lancet Psychiatry Commission on youth mental health🔓
The Lancet Psychiatry
Mental ill health, which has been the leading health and social issue impacting the lives and futures of young people for decades, has entered a dangerous phase. Accumulating research evidence indicates that in many countries, the mental health of emerging adults has been declining steadily over the past two decades, with a major surge of mental ill health driven by the COVID-19 pandemic, the measures taken to contain it, and its aftermath. This alarming trend signals a warning that global megatrends (major, long-lasting societal changes such as environmental, social, economic, political, or technological changes) and changes in many societies around the world in the past two decades have harmed the mental health of young people and increased mental ill health among them.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors
JAMA Network Open
This British study included 135,103 older (median age 64) adults and compared drinking patterns with mortality during a median follow-up of 12 years. Compared to occasional drinkers, low-risk drinkers had higher cancer mortality (HR, 1.11), moderate-risk drinkers had higher all-cause and cancer mortality (HRs, 1.10 and 1.15), and high-risk drinking had higher all-cause, cancer, and cardiovascular mortality (HRs, 1.33, 1.39, and 1.21). These results contrast with earlier studies showing protective effects of low- to moderate-risk drinking. Researchers used occasional drinkers as the control group, where previous studies used abstainers including former drinkers with residual health effects. There was a small protective effect of drinking only with meals and drinking wine. In conclusion, the authors failed to find a protective effect of low-risk drinking on mortality.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Physician Reluctance to Intervene in Addiction: A Systematic Review
JAMA Network Open
This systematic review of 283 articles explored the reasons physicians give for not addressing substance use and addiction in their clinical practice. The institutional environment (81.2% of articles) was the most common reason given for physicians not intervening in addiction, followed by lack of skill (73.9%), cognitive capacity (73.5%), and knowledge (71.9%). These findings suggest that efforts should be directed at creating institutional environments that facilitate the delivery of evidence-based addiction care while improving access to education and training opportunities for physicians to practice the necessary skills.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Host Dr. Nick Athanasiou sat down with Drs. Matisyahu Shulman and Adam Bisaga to discuss the study they recently authored titled Rapid Initiation of Injection Naltrexone for Opioid Use Disorder: A Stepped-Wedge Cluster Randomized Trial. The doctors share their findings and the impact and implications of the study.
Subscribe to The ASAM Weekly to read the guest editorial:
Guest Editorial: Rapid Initiation of Injectable Extended-Release Naltrexone for Opioid Use Disorder: A Time for Paradigm Shift in Treatment Protocols
This project has been funded as a whole or in part with Federal funds from the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, under Contract No. 75N95020C00028.
-
Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders
JAMA Psychiatry
This is a survey study of 4,674 participants from US households that examined the association between social vulnerability and mental health and substance use disorders and related treatment in the US noninstitutionalized population of adults aged 18 years and older. Large increases in several mental health and substance use disorders and corresponding decreases in treatment were found in the most socially vulnerable communities. The findings suggest that routine measurement of social vulnerability might assist in developing more comprehensive care models that integrate medical and social care for mental health and substance use disorders.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Psilocybin desynchronizes the human brain
Nature
To assess how human brain network changes relate to the subjective and lasting effects of psychedelics, this study tracked individual-specific brain changes with longitudinal precision functional mapping (roughly 18 magnetic resonance imaging visits per participant). Psilocybin massively disrupted functional connectivity (FC) in the cortex and subcortex, acutely causing more than threefold greater change than methylphenidate. These FC changes were driven by brain desynchronization across spatial scales (areal, global), which dissolved network distinctions by reducing correlations within and anticorrelations between networks. Persistent reduction of hippocampal-default mode network connectivity may represent a neuroanatomical and correlate of the proplasticity and therapeutic effects of psychedelics.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Secondhand Nicotine Absorption From E-Cigarette Vapor vs Tobacco Smoke in Children
JAMA Network Open
This cross-sectional study of 1,777 US children aged 3 to 11 years examined how children’s nicotine absorption, as indexed by serum cotinine level, differ among those exposed to (1) secondhand tobacco smoke only, (2) secondhand e-cigarette vapor only, or (3) neither. Compared with children exposed to secondhand smoke only, nicotine absorption was 83.6% lower in those exposed to secondhand vapor only and 96.7% lower in those exposed to neither. These findings suggest that children absorb much more nicotine from secondhand smoke than from secondhand vapor; switching from smoking to vaping indoors may substantially reduce children’s secondhand exposure to nicotine and other noxious substances, but both smoke and vapor increase children’s absorption vs no exposure.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Benzodiazepine use in relation to long-term dementia risk and imaging markers of neurodegeneration: a population-based study 🔓
BMC Medicine
This study examined the relationship between benzodiazepine (BZD) use and dementia, using data from the population-based Rotterdam (Netherlands) study started in 1990. For 5,443 participants, BZD use during the 15 years from 1990 to 2005 was compared to dementia screens performed through 2020. Half of the participants had used BZD at some time during the 15-year baseline, and 13% developed dementia. Overall, there was no association between BZD use and dementia risk. However, the use of BZD as an anxiolytic in higher doses was associated with dementia risk (HR=1.3). The authors note that BZD with longer half-life are used as anxiolytics, whereas short half-life BZD are used as sedative-hypnotics. A reduction in hippocampal volume on MRI was also associated with BZD use. Overall, there was no association of BZD use with dementia risk, however, some associations were observed that deserve further study.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Extended-release ketamine tablets for treatment-resistant depression: a randomized placebo-controlled phase 2 trial
Nature Medicine
The safety and tolerability of racemic ketamine may be improved if given orally, as an extended-release tablet (R-107), compared with other routes of administration. In this phase 2 multicenter clinical trial, male and female adult patients with treatment-resistant major depression (TRD) and Montgomery–Asberg Depression Rating Scale (MADRS) scores ≥20 received open-label R-107 tablets 120 mg per day for 5 days and were assessed on day 8 (enrichment phase). On day 8, responders (MADRS scores ≤12 and reduction ≥50%) were randomized to receive double-blind R-107 doses of 30, 60, 120, or 180 mg, or placebo, twice weekly for 12 weeks. Nonresponders on day 8 exited the study. Tolerability was excellent, with no changes in blood pressure, minimal reports of sedation, and minimal dissociation. The most common adverse events were headache, dizziness, and anxiety. R-107 tablets were effective, safe, and well tolerated in patients with TRD, enriched for initial response to R-107 tablets.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Global status report on alcohol and health and treatment of substance use disorders
World Health Organization
This report utilizes data from the WHO member states to summarize alcohol consumption, its health consequences, and alcohol policies around the world. Overall, there was a decrease in alcohol consumption between 2010 and 2019, but alcohol-related deaths still accounted for 4.7% of all deaths in 2019. Despite the burden, there are still significant gaps in access to and types of treatment available worldwide, with the percentage of patients with substance use disorder receiving care ranging from 1% to 30% in countries that gather that data. The report makes several recommendations to address the concern, including a global advocacy campaign, increased training for health professionals at all levels, international knowledge transfers, and resource mobilization.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths
The New England Journal of Medicine
HEALing (Helping to End Addiction Long-term Initiative) Communities Study (HCS) investigators examined the potential of the community-engaged, data-driven Communities That HEAL (CTH) intervention to reduce the rate of opioid-related overdose deaths in highly affected communities. Intervention communities implemented hundreds of strategies to expand opioid overdose education and naloxone distribution, the use of medications for opioid use disorder, and safety measures for prescription opioid use, as well as communication campaigns to support these efforts. Although there were no significant between-group differences in the rate of opioid-related overdose deaths, the trial showed that the CTH community-engaged intervention, with its leveraging of community coalitions and a data-driven approach, can bring about meaningful progress in implementing evidence-based practices.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
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 examine 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.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Associations of semaglutide with incidence and recurrence of alcohol use disorder in real-world population
Nature Communications
In this retrospective cohort study of patients receiving medication for treatment of obesity, the authors evaluated the association of semaglutide with incidence of and recurrence of alcohol use disorder (AUD). In the cohort patients received semaglutide or non-GLP1RA medications, including naltrexone and topiramate. In matched cohort analysis, patients who received semaglutide had much lower rates of incident AUD (HR=0.5) compared to those receiving non-GLP1RA medications and in sub-analysis comparing semaglutide to naltrexone/topiramate the also had lower incident AUD (HR=0.44). Among those with a history of AUD, semaglutide was also associated with lower recurrence of AUD (HR=0.44) overall and in sub-analysis (HR=0.25). These findings support potential benefit of semaglutide for AUD in a real-world population and need for randomized clinical trials.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Innovation and adaptation: The rise of a fentanyl smoking culture in San Francisco
Plos One
This is a qualitative study describing the growing practice in the San Francisco area of smoking rather than injecting fentanyl. Fentanyl salts are stable up to 350°C making heating and inhalation more effective than for heroin. Some of the increase in smoking is driven by users’ difficulty finding accessible veins. There is also the perception that smoking presents less of a risk of overdose compared to injection. It is unclear if smoking is safer and overdose deaths continue to rise in San Francisco. Over time a brown residue accumulates that contains a high concentration of drug. The smoking equipment is often used for both methamphetamine and fentanyl so this residue contains an unknown mixture of the history of the drugs consumed. The residue is valued for potency but presents a new overdose risk due to the unknown amounts of drugs it contains.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Rapid Initiation of Injection Naltrexone for Opioid Use Disorder
JAMA Network
Standard initiation procedures (SP) for extended-release (XR)-naltrexone can be a barrier to initiation for patients. In this stepped-wedge cluster-randomized trial, they compared SP initiation (3-5 days buprenorphine taper, 7-10 days opioid-free) to a rapid procedure (RP) initiation (1 day buprenorphine, 1 day opioid free, 3-4 days ascending dose of oral naltrexone). Patients in the RP group (62.7%) were more likely to receive the initial XR-naltrexone dose (OR 3.6, P<0.001) than the SP group (35.8%). There was not a statistically significant difference between the groups in rate of 2nd and 3rd doses. The study demonstrates that RP for initiation of XR-naltrexone is non-inferior to SP and may lead to shorter in-patient stay.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment
JAMA Psychiatry
Studies have demonstrated that childhood maltreatment is strongly associated with mental health conditions, but this study uses a quasi-experimental design and meta-analysis to assess proportion of various mental health issues that are attributed to childhood maltreatment. The authors found that approximately 25% of mental health disorders (anxiety, depression, alcohol use disorder (AUD), substance use disorders (SUD), self-harm, and suicide) could be attributed to childhood mistreatment, accounting for approximately 1.8 million cases in Australia. Approximately 27% of AUD and 32% of SUD were attributed to childhood maltreatment. The findings strongly support the importance of efforts to prevent childhood maltreatment.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Associations of cannabis use, use frequency, and cannabis use disorder with violent behavior among young adults in the United States
International Journal of Drug Policy
An association between cannabis use and violent behavior has previously been reported, so the authors used the 2015-2019 National Survey on Drug Use and Health to better explore this association. In adjusted models, the authors found an increased prevalence of violent behavior among males reporting daily cannabis use with and without cannabis use disorder (CUD) versus no cannabis use. However, there was no increase among males reporting non-daily cannabis use with or without CUD. Researchers found an increase in violent behavior among females reporting non-daily use with or without CUD and daily use with or without CUD. While additional research is needed to better understand this relationship and the sex differences, these findings support the importance of early screening and treatment for CUD.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
-
Lead Story
Biomarkers of metal exposure in adolescent e-cigarette users: correlations with vaping frequency and flavouring
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.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
- Visa fler