Addiction Medicine and Addiction Psychiatry Updates

Adjunctive Ketamine With Relapse Prevention–Based Psychological Therapy in the Treatment of Alcohol Use Disorder Published Online: 11 Jan 2022 https://doi.org/10.1176/appi.ajp.2021.21030277 Objective: Early evidence suggests that ketamine may be an effective treatment to sustain abstinence from alcohol. The authors investigated the safety and efficacy of ketamine compared with placebo in increasing abstinence in patients with alcohol use disorder. An additional aim was to pilot ketamine combined with mindfulness-based relapse prevention therapy compared with ketamine and alcohol education as a therapy control. Methods: In a double-blind placebo-controlled phase 2 clinical trial, 96 patients with severe alcohol use disorder were randomly assigned to one of four conditions: 1) three weekly ketamine infusions (0.8 mg/kg i.v. over 40 minutes) plus psychological therapy, 2) three saline infusions plus psychological therapy, 3) three ketamine infusions plus alcohol education, or 4) three sal...

Williams, K. D., and R. I. Field. 2022. Buprenorphine Prescribing through Telemedicine and Telephone Evaluation: Time for an Overdue Update in Policy.  " It should not be more difficult for health care providers to prescribe life-saving medications that treat opioid use disorder than to prescribe addictive opioid pills themselves. Yet, that is the reality clinicians face today." NAM Perspectives . Commentary, National Academy of Medicine, Washington, DC.  https://doi.org/10.31478/202201d .

Risk for opioid misuse in chronic pain patients is associated with endogenous opioid system dysregulation Javier Ballester ,  Anne K. Baker ,  Ilkka K. Martikainen ,  Vincent Koppelmans ,  Jon-Kar Zubieta  &  Tiffany M. Love   Translational Psychiatry   volume  12 , Article number:  20  ( 2022 )  " We found that chronic pain participants at high risk for opioid misuse displayed higher baseline MOR availability within the right amygdala relative to those at low risk. By contrast, patients at low risk for opioid misuse showed less pain-induced activation of MOR-mediated, endogenous opioid neurotransmission in the nucleus accumbens. This study links human in vivo MOR system functional measures to the development of addictive disorders and provides novel evidence that MORs and µ-opioid system responsivity may underlie risk to misuse opioids among chronic pain patients."

Availability of Medications for the Treatment of Opioid Use Disorder Among Pregnant and Postpartum Individuals in US Jails Carolyn Sufrin, MD, PhD ;   Camille T. Kramer, MPH ;   Mishka Terplan, MD, MPH ;   Kevin Fiscella, MD, MPH ;   Sarah Olson, MPH ;   Kristin Voegtline, PhD ;   Carl Latkin, PhD JAMA Netw Open.   2022;5(1):e2144369. doi:10.1001/jamanetworkopen.2021.44369 This study from Johns Hopkins, Friends Research Institute and University of Rochester found that "US jails did not consistently provide pregnant people with access to medications that meet the standard of care for treatment of opioid use disorder, which suggests that there is an opportunity for intervention to improve care for pregnant people who are incarcerated."

After adjusting for several patient characteristics as well as recent exposure to other illicit substances, patients who tested positive for THC at last follow up were found to be: 2.7 times more likely to develop delayed cerebral ischemia; 2.8 times more likely to have long-term moderate to severe physical disability; and 2.2 times more likely to die. Stroke , 2022; DOI:  10.1161/STROKEAHA.121.035650

In June 2021, the US Drug Enforcement Administration (DEA) released the mobile methadone rule,  a long-anticipated policy intended to expand methadone access by allowing OTPs to create mobile treatment units under their existing waivers. Read more in JAMA Psychiatry

Low dose inductions with overlap of full opioid agonists were largely successful in transitioning hospitalized patients from full agonist opioids to buprenorphine. However, there were several factors associated with lower likelihood of success. Future work could focus on treatment of withdrawal symptoms and system-level changes ensuring patient-centered medication decisions. Journal of Addiction Medicine:  December 23, 2021 - Volume - Issue -    doi: 10.1097/ADM.0000000000000947