Addiction Medicine and Addiction Psychiatry Updates

Reuters:   A secretive route that drug traffickers use to transport fentanyl-making chemicals from China to Mexico runs straight through the United States. It’s called the “master carton” smuggling scheme, and it all starts with one little box. https://www.reuters.com/investigates/special-report/usa-fentanyl-supply-chain-shipping/

This brochure explains the Federal laws that prohibit discrimination against individuals with disabilities and how they protect people receiving Medication Assisted Treatment for opioid addiction (also known as “MAT”).  MAT includes a medication (e.g., methadone, buprenorphine, oral naltrexone) approved by the U.S. Food and Drug Administration (FDA) for opioid addiction detoxification or maintenance treatment.  https://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/Know-Your-Rights-Brochure.pdf  

The   PATHS toolkit   offers evidence-based educational resources about the use of medication to treat opioid use disorder (OUD) during and after pregnancy. Culturally and linguistically appropriate versions are also available for  American Indians & Alaska Natives  and Spanish speakers (coming soon) . Resources include videos, discussion guides, fact sheets, flyers, posters, and social media messaging.   https://ctnlibrary.org/paths-oud-nida-ctn-di/  

This cohort study in 135,103 older drinkers found that even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. Wine preference and drinking only with meals were associated with attenuating the excess mortality associated with alcohol consumption. Ortolá R ,  Sotos-Prieto M ,  García-Esquinas E ,  Galán I ,  Rodríguez-Artalejo F. Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors.  JAMA Netw Open.  2024;7(8):e2424495. doi:10.1001/jamanetworkopen.2024.24495

Not all patients respond to effective and approved treatment interventions, and there has been growing recognition in the medical field of these “resistant” or refractory illnesses (eg, treatment-resistant depression, resistant hypertension). In the field of substance use disorders, there has not been an explicit acknowledgement of treatment-refractory addiction (TRA) despite substantial evidence that many patients do not respond to standard-of-care treatment interventions. This article provides a justification for TRA as a critically important condition to recognize and define. TRA is not conceptualized as a diagnosis, but as a signal that a current treatment approach has not worked. The article addresses areas in need of research and consensus in order to ensure the approach to TRA is uniform, thoughtfully addressed, and data-driven. By explicitly acknowledging TRA, clinicians, researchers, and patients and their families can begin to explore the unique features of this population an

Question     What reasons do physicians give for not addressing substance use and addiction in their clinical practice? Findings     In this systematic review of 283 articles, 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%). Meaning     These findings suggest effort should be directed at creating institutional environments that facilitate delivery of evidence-based addiction care while improving access to both education and training opportunities for physicians to practice necessary skills. JAMA Netw Open.  2024;7(7):e2420837. doi:10.1001/jamanetworkopen.2024.20837 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821497