Addiction Medicine and Addiction Psychiatry Updates

The  Boston Medical Center’s Clinical Addiction Research & Education (CARE) Unit  puts out a regular online newsletter "Alcohol, Other Drugs, and Health: Current Evidence."   They also post PowerPoint presentations that mirror each newsletter and online curricula in SUDs.  They host a monthly virtual journal club.  Check out their site!

New Medicaid Option Promotes Enhanced Mental Health, Substance Use Crisis Care The Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is working with states to promote access to Medicaid services for people with mental health and substance use disorder (SUD) crises. Authorized under President Biden’s American Rescue Plan (ARP), states have a new option for supporting community-based mobile crisis intervention services for individuals with Medicaid. Mobile crisis intervention services are essential tools to meet people in crisis where they are and rapidly provide critical services to people experiencing mental health or substance use crises by connecting then to a behavioral health specialist 24 hours per day, 365 days a year. This new option will help states integrate these services into their Medicaid programs, a critical component in establishing a sustainable and public health-focused support network.

Truong TT and Kosten TR.   Journal of the Neurological Sciences    Volume 434 ,   15 March 2022, 120098 "Vaccines for substance use disorders have faced significant challenges in transition for use in humans."  Link to article for more highlights and a review of human studies.

Molecular switch for addiction behavior: Newly discovered mechanism determines how strongly mice respond to cocaine A molecular switch influences addiction behavior and determines how strong the response to addictive drugs is. A research team made the discovery in mice treated with cocaine. The researchers demonstrated that the protein Npas4 regulates the structure and function of nerve cells that control addiction behavior in mice. If the quantity of Npas4 was reduced in an experiment, the animals' response to cocaine was much weaker. https://pubmed.ncbi.nlm.nih.gov/34661342/ 

"This report highlights four main findings regarding IMF-involved deaths: 1) deaths increased sharply in midwestern, southern, and western jurisdictions during 2019–2020; 2) approximately four in 10 deaths also involved stimulants; 3) approximately one half of decedents had no pulse when first responders arrived; and 4) evidence of injection was the most frequently documented route of drug use, but substantial percentages of deaths likely involved other routes, especially in the West." Morbidity and Mortality Weekly Report Early Release / Vol. 70  December 14, 2021

  A vicious cycle of neuropathological, cognitive and behavioural sequelae of repeated opioid overdose. Voronkov M, Ataiants J, Cocchiaro B, Stock JB, Lankenau SE.   Int J Drug Policy. 2021 Nov;97:103362. doi: 10.1016/j.drugpo.2021.103362. Epub 2021 Jul 24. " Findings point to a vicious cycle of nonfatal overdose leading to neurodegeneration - closely resembling Alzheimer Disease - that results in cognitive decline that in turn leads to potentially reduced adherence to safe drug use behaviours."

BUPE:POC Tool Created in partnership with the  American College of Emergency Physicians   (ACEP), The BUPE:POC Tool helps Emergency Physicians assess patients for opioid withdrawal and guides the use of buprenorphine. This tool provides quick access to indications, side effects and expected response.

Risks and Benefits of Cannabis and Cannabinoids in Psychiatry , American Journal of Psychiatry, 2021 Dec 8. In this review, the authors outline the evidence from randomized double-blind placebo-controlled trials for therapeutic use of cannabinoids for specific medical conditions and the potential side effects associated with acute and chronic cannabis use. .... Results:  There are currently no psychiatric indications approved by the U.S. Food and Drug Administration (FDA) for cannabinoids, and there is limited evidence supporting the therapeutic use of cannabinoids for treatment of psychiatric disorders. To date, evidence supporting cannabinoid prescription beyond the FDA indications is strongest for the management of pain and spasticity.   Conclusions:  As cannabinoids become more available, the need for an evidence base adequately evaluating their safety and efficacy is increasingly important. There is considerable evidence that cannabinoids have a potential for harm in vulnerable po

From NDEWS:   NPS Discovery published a public alert last week on the adverse effects linked to next generation opioids reported in patients presenting to emergency departments after suspected opioid overdose.   Read the full report here .

See the full AAAP 2021 Conference schedule here. How does one do contingency management in an SUD clinic? See this video for an example of drawing chances as reinforcers for negative urine drug screens:  https://www.youtube.com/watch?v=gD1dMBWCR4w