Addiction Medicine and Addiction Psychiatry Updates

Schuster, Rilana, et al. "Calcium Carbonate Attenuates Withdrawal and Reduces Craving: A Randomized Controlled Trial in Alcohol-Dependent Patients."  European Addiction Research  (2021): 1-9. https://www.karger.com/ Article/Abstract/512763 Kemény, Lajos V., et al. "Vitamin D deficiency exacerbates UV/endorphin and opioid addiction."  Science Advances  7.24 (2021): eabe4577. https://www.science.org/doi/ pdf/10.1126/sciadv.abe4577 Ghaderi, Amir, et al. "The effects of Vitamin D supplementation on withdrawal symptoms and the expression of inflammatory cytokines and insulin in patients under methadone maintenance treatment: A randomized, double-blind, placebo-controlled trial."  Iranian Journal of Psychiatry and Behavioral Sciences  14.1 (2020). https://eprints.iums.ac.ir/ 23915/1/The_Effects_of_ Vitamin_D_Supplementation_on_ Withdr.pdf Eserian, Jaqueline Kalleian. "Vitamin D as an effective treatment approach for drug abuse and addiction."  Journal ...

"This is the first lab confirmed case of marijuana with fentanyl in Connecticut and possibly the first confirmed case in United States," DPH Commissioner Dr. Manisha Juthani said. NBConnecticut, 11/19/2021.

  Academic Centers Start to Take Psychedelics Seriously Update on research using psychedelic drugs for PTSD and other mental disorders:  " After a half-century of dwindling research funding amid political backlash, research on psychedelics such as psilocybin, LSD, Ayahuasca, mescaline, and similar substances is experiencing something of a revival -- to the extent that several prestigious academic institutions now house dedicated psychedelic research centers.   "  MedPageToday, 11/24/2021 Also see: Johns Hopkins Medicine Receives First Federal Grant for Psychedelic Treatment Research in 50 years, 10/18/2021

"Psychedelic use is associated with reduced daily opioid use among people who use illicit drugs in a Canadian setting":   International Journal of Drug Policy ,  Volume 100 ,   February 2022 . Highlights • Recent psychedelic use was associated with 55% reduced odds of daily opioid use. • This is the first longitudinal study to link psychedelic use with lower daily opioid use. • More studies are needed to elucidate the therapeutic potential of psychedelics.

BUPE2021  (https://bupe2021.com/) is a one day virtual conference that is an extension of  Journal of Opioid Management’s  Special Issue on Buprenorphine. More than a conference, BUPE2021 is presented by the Journal of Opioid Management and is a resource for those looking to learn about this interesting molecule .  The Conference expands on the recent JOM special issue on Buprenorphine, 2021, available here .

The latest report from the National Forensic Laboratory Information Systems (NFLIS)::: The Top 5 Most Frequently Identified Drugs in the U.S. in 2020 were: 1.  Methamphetamine 2.  Cannabis/THC 3.  Cocaine 4.  Fentanyl 5.  Heroin The complete NFLIS-Drug 2020 Annual Report can be downloaded:  https://www.nflis.deadiversion.usdoj.gov/nflisdata/docs/NFLISDrug2020AnnualReport.pdf

International Journal of Drug Policy , Volume 98 , December 2021. "Novel psychoactive substances (NPS) present continuous and growing challenges for the scientific, medical, and interventional communities as emerging substances on recreational drug markets change national and international drug landscapes. NPS account for an increasing proportion of adverse events, hospitalizations, and deaths due to increasing potency and unanticipated biological effects compared to predecessors. This study evaluated the utility of drug use forums as an early indicator or predictor of impending intoxications with potentially harmful or lethal outcomes prior to their occurrences."

"There were no COVID-19 related deaths among the 188 SARS-CoV-2 positive patients treated with disulfiram, in contrast to 5–6 statistically expected deaths based on the untreated population (P = 0.03). Our epidemiological results suggest that disulfiram may contribute to the reduced incidence and severity of COVID-19. These results support carefully planned clinical trials to assess the potential therapeutic effects of disulfiram in COVID-19." Also see Harvard Gazette coverage here.    Veterans who were taking disulfiram had a 34 percent lower incidence of SARS-CoV-2 infection than those who weren’t, according to a retrospective study.

NY Times: More than 100,000 Americans died from drug overdoses in the yearlong period ending in April, government researchers said.

Project SCOPE: Supporting Children of the OPioid Epidemic , is a national training initiative intended to  build nationwide provider capacity and confidence in applying evidence-based practices  in screening, monitoring, and interdisciplinary support for children and families diagnosed with Neonatal Abstinence Syndrome (NAS), Neonatal Opioid Withdrawal Syndrome (NOWS), or who are suspected of being impacted by opioid use, trauma, or related exposure. Utah State University, University of Utah ECHO office.  Biweekly from August 11, 2021-December 15, 2021.

 ASAM just released a Toolkit  " Speaking the Same Language." Toolkit Offers Strategies and Tools for Strengthening Patient-Centered Addiction Care in the United States. The new toolkit, authored by Manatt Health Strategies in collaboration with the American Society of Addiction Medicine and Well Being Trust, provides ways for ensuring consistent use of patient-centered addiction care across providers, payers, and patients. This is "a new resource designed to assist states looking to establish a strong, consistent framework, such as The ASAM Criteria ® , for patient-centered, evidence-based addiction care.  By helping providers, payers, and patients “speak the same language” when it comes to addiction care, this first-of-its-kind toolkit will facilitate continuity and consistency in substance use disorder (SUD) treatment delivery and coverage."

Most people have heard of the 12 Steps and 12 Traditions of Alcoholics Anonymous (AA).  But have you heard about the 12 Promises of AA?  They are contained in Chapter 6 of the Big Book of Alcoholics Anonymous, on pages 83-84.  See the Promises here and a commentary on the Promises here.

  Conclusions The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons. Ulrich John, Hans-Juergen Rumpf, Monika Hanke, Christian Meyer.  Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study .   PLOS Medicine , 2021; 18 (11): e1003819 DOI:   10.1371/journal.pmed.1003819

The Jingle Dress:  The story behind a Native American dance and its power of spiritual healing, ABC News When the United States was hit with the influenza pandemic in 1918, the women of the Ojibwe tribe practiced a healing ritual known as "the jingle dress" dance. It is characterized by the tinkling sounds made by the silver cones that adorn the dress each time the dancer moves.....

Embracing Community and Culture to Prevent Underage Drinking Posted on  November 4, 2021 By George F. Koob, Ph.D. Director, National Institute on Alcohol Abuse and Alcoholism Supporting research to better understand and address alcohol-related health disparities and improve the health of underserved populations is one of the highest priorities of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Among our efforts is NIAAA’s long-term investment in preventing underage drinking. Early initiation of alcohol consumption and heavy drinking increases the risk of alcohol use disorder (AUD) and related consequences over a person’s lifetime, and alcohol intervention efforts started at a young age can positively influence a young person’s path in life. Research indicates that prevention efforts involving the community and/or informed by the community’s cultural beliefs hold promise for preventing and reducing underage drinking....

Young-Wolff KC, Ray GT, Alexeeff SE, Adams SR, Does MB, Ansley D, Avalos LA. Rates of Prenatal Cannabis Use Among Pregnant Women Before and During the COVID-19 Pandemic. JAMA. 2021 Nov 2;326(17):1745-1747. doi: 10.1001/jama.2021.16328. PMID: 34570168; PMCID: PMC8477300.

Treatment of overdose in the synthetic opioid era. Skolnick P. Pharmacol Ther. 2021 Oct 9:108019. doi: 10.1016/j.pharmthera.2021.108019. Online ahead of print. PMID:  34637841   Review. Overdose deaths are often viewed as the leading edge of the opioid epidemic which has gripped the United States over the past two decades (Skolnick, 2018a). This emphasis is perhaps unsurprising because  opioid overdose  is both the number-one cause of death for individuals between 25 and 64 years old (Dezfulian et al., 2021) and a significant contributor to the decline in average lifespan (Dowell et al., 2017). Exacerbated by the COVID 19 pandemic, it was estimated there were 93,400  drug overdose  deaths in the United States during the 12 months ending December 2020, with more than 69,000 (that is, >74%) of these fatalities attributed to opioid overdose (Ahmad et al., 2021). However, the focus on mortality statistics (Ahmad et al., 2021; Shover et al., 2020) t...

Depress Anxiety .  2016 Aug;33(8):718-27. "Ketamine was discovered in the 1960s and released for public use in 1970. Originally developed as a safer alternative to phencyclidine, ketamine is primarily used in clinical settings for analgesia and sedation. In recent years, other uses have been developed, including pain management and treatment of asthma and depression. Clinical use of ketamine causes dissociation and emergence delirium. These effects have led to recreational abuse. Although death from direct pharmacologic effects appears rare, the disinhibition and altered sensory perceptions caused by ketamine puts users at risk of environmental harm. Ketamine has also been implicated in nonconsensual sexual intercourse. Data continue to build that chronic ketamine use may lead to morbidity. Impairment of memory and persistent dissociative, depressive, and delusional thinking has also been reported with long-term use. Lower urinary tract symptoms, including cystitis have been descr...

  Includes withdrawal syndromes from benzodiazepines, ketamine/esketamine, mood stabilizers. Psychother Psychosom 2020;89:283–306.  " Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63–71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders."

World Psychiatry   2021 Oct 5. Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021

  DEA Warns that Pills Purchased Outside of a Licensed Pharmacy are Illegal, Dangerous, and Potentially Deadly https://www.dea.gov/onepill

Addiction: An International Problem Needing Global Solutions International Society of Addiction Medicine (ISAM)  https://isamcongress.org/about/program/ Nov. 19-21, 2021

  https://www.biologicalpsychiatryjournal.com/article/S0006-3223(21)01369-X/fulltext Transcriptional Alterations in Dorsolateral Prefrontal Cortex and Nucleus Accumbens Implicate Neuroinflammation and Synaptic Remodeling in Opioid Use Disorder, 2021 "Prevalence rates of opioid use disorder (OUD) have increased dramatically, accompanied by a surge of overdose deaths. While opioid dependence has been extensively studied in preclinical models, an understanding of the biological alterations that occur in the brains of people who chronically use opioids and who are diagnosed with OUD remains limited. To address this limitation, RNA sequencing was conducted on the dorsolateral prefrontal cortex and nucleus accumbens, regions heavily implicated in OUD, from postmortem brains in subjects with OUD.... Rank-rank hypergeometric overlap analyses revealed extensive overlap in transcripts between the dorsolateral prefrontal cortex and nucleus accumbens in OUD, related to synaptic remodeling and...

  Utah Department of Health mortality data shows that the number of deaths involving fentanyl more than doubled from 2019 to 2020 (125% increase) and that this trend has continued into 2021. Further highlighting this alarming trend, from January to March of 2021, the Utah Highway Patrol has reported more than a 900% increase in fentanyl seizures, compared to all of 2020.   Fentanyl Report :   Utah Drug Monitoring Initiative   :::  A joint publication of public health and public safety agencies in the State of Utah  ::: ::: June 2021 ::: This report was created through The Utah Drug Monitoring Initiative (DMI), a multi-agency program focused on collaboration and information sharing between Utah law enforcement and public health agencies. The purpose of this report is to alert policymakers and other critical decision makers in the State of Utah to the urgent problem presented by fentanyl and other synthetic opioids in Utah. This report provides the most ...

  1,2-Propylene Glycol: A Biomarker of Exposure Specific to e-Cigarette Consumption  ::: This is an open access article distributed under the  Creative Commons Attribution License  which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Nicotine Exposure and Metabolites, ARUP Consult. It's helpful to know if a lab result indicates nicotine replacement therapy usage or tobacco use.  See this link for the answers to your questions about this distinction.