Addiction Medicine and Addiction Psychiatry Updates

American Journal on Addictions, 2022.  https://doi.org/10.1111/ajad.13257 --Virtually all PHP program components were rated as being at least “somewhat helpful” in promoting recovery, with the plurality of respondents rating almost all components as “extremely helpful.” The top-rated components were: signing a PHP monitoring agreement, participation in the PHP, formal SUD treatment, and attending 12-step meetings...Notably, 88% of respondents endorsed continued participation in 12-step fellowships. Despite the significant financial burden of PHP participation, 85% of respondents reported they believed the total financial cost of PHP participation was “money well spent.”

CRAFT Connect Family Support is a respectful, loving, non-confrontational set of principles and skills that will teach you how to mindfully encourage your loved one to make choices that lead to progress and healing. It is focused on behavior change that has been proven to help everyone in the family. It is a combination of recovery related Evidence-Based-Practices including Community Reinforcement & Family Training (CRAFT), Peer Support, Dialectical Behavioral Therapy (DBT), Wellness, Motivational Interviewing (MI), Mindfulness and Expressive Writing. Many free resources and connections available here: https://www.craftconnectfs.com/

FDA has become aware of safety reports involving compounded intranasal ketamine to treat psychiatric disorders which may be putting patients at risk. Compounded drugs are not FDA-approved, which means FDA has not evaluated their safety, effectiveness, or quality prior to marketing. https://www.fda.gov/drugs/human-drug-compounding/fda-alerts-health-care-professionals-potential-risks-associated-compounded-ketamine-nasal-spray

MATα1 catalyzes the synthesis of S-adenosylmethionine, the principal biological methyl donor. Lower MATα1 activity and mitochondrial dysfunction occur in alcohol-associated liver disease. Besides cytosol and nucleus, MATα1 also targets the mitochondria of hepatocytes to regulate their function. Here, we show that mitochondrial MATα1 is selectively depleted in alcohol-associated liver disease through a mechanism that involves the isomerase PIN1 and the kinase CK2. Alcohol activates CK2, which phosphorylates MATα1 at Ser114 facilitating interaction with PIN1, thereby inhibiting its mitochondrial localization. Blocking PIN1-MATα1 interaction increased mitochondrial MATα1 levels and protected against alcohol-induced mitochondrial dysfunction and fat accumulation. Normally, MATα1 interacts with mitochondrial proteins involved in TCA cycle, oxidative phosphorylation, and fatty acid βoxidation. Preserving mitochondrial MATα1 content correlates with higher methylation and expression of mitocho

Boston Medical Center's (BMC) Office Based Addiction Treatment (OBAT) Training and Technical Assistance (TTA) provides education, support and capacity building to community health centers and other health care and social service providers on best practices caring for patients with substance use disorders.   https://www.bmcobat.org/quick-start/ Also check out the BMC MAT Quick Start app, available on the App Store or Google Play .

"Z-drugs and gabapentinoids are increasingly involved in overdose deaths in the USA over the past two decades. Furthermore, they are also increasingly present in opioid or benzodiazepine-related overdose deaths. This suggests those drugs can pose their own harms. Clinicians should be aware when prescribing, especially when trying to replace benzodiazepines or opioids, as z-drugs and gabapentinoids can be misused concurrently with the substances they intend to replace." https://www.sciencedirect.com/science/article/pii/S2667193X22000072?via%3Dihub 

Could an unusual drug habit account for such a rapid decline?  https://www.nytimes.com/2022/01/12/magazine/nitrous-oxide-whippets-vitamin-b12.html

CDC’s National Center for Injury Prevention and Control is in the process of updating the   2016 CDC Guideline for Prescribing Opioids for Chronic Pain . The draft updated Clinical Practice Guideline for Prescribing Opioids is available for public comment in the Federal Register. The public comment period will be open for 60 days, through April 11, 2022. We encourage all patients, caregivers, providers, and others who care about safe, effective, and informed pain treatment options to submit their comments via the Federal Register docket. It is vitally important to CDC that we receive, process, and understand public feedback during the guideline update process. The guideline is intended to be a clinical tool to improve communication between providers and patients and empower them to make informed, patient-centered decisions related to safe and effective pain care. The guideline recommendations are voluntary and are not intended to be applied as inflexible standards of care or replace cl

2/16/2022:  Today the American Society of Addiction Medicine (ASAM) and the University of California, Los Angeles Integrated Substance Abuse Programs (UCLA ISAP) released a new, paper-based resource to support more consistent and effective implementation of  The ASAM Criteria ® , a national framework for patient-centered, evidence-based addiction care. The ASAM Criteria Assessment Interview Guide  is the first publicly available standardized version of  The ASAM Criteria  assessment. With this release, ASAM and UCLA hope to increase the quality and consistency of patient assessments and treatment recommendations. As discussed in the recently released  Speaking the Same Language: A Toolkit for Strengthening Patient-Centered Addiction Care in the United States ,  this resource can also help assist states looking to facilitate continuity and consistency in substance use disorder (SUD) treatment delivery and coverage. Because it is paper based, offered free to all clinicians, and can be us

These interprofessional modules for students, health care providers and LTSS staff are centered around opioid use, including topics such as: Reasons for prescribing opioids to treat acute and chronic pain Pharmacology of opioid use in older adults with multiple chronic conditions including dementia Appropriate prescribing of opioids in nursing home residents Opioid misuse in nursing home residents including assessment and treatment Non-opioid pharmacologic and non-pharmacologic pain management regimens Utah Geriatric Education Consortium:: https://utahgwep.org/trainings/managing-opioid-use-in-long-term-services-and-support 

Question    Are specific communication strategies effective in reducing stigma toward people with opioid use disorder (OUD) among health care professionals? Findings    In this randomized clinical trial involving a national sample of 1842 health care professionals, exposure to visual campaigns combined with short narrative vignettes told from the perspective of a patient with OUD that emphasized the harm of stigmatizing language or the effectiveness of medications for treating OUD was associated with reduced levels of stigma. Meaning     The findings of this randomized clinical trial suggest that carefully designed communication campaigns may reduce OUD-related stigma among health care professionals. Kennedy-Hendricks A, McGinty EE, Summers A, Krenn S, Fingerhood MI, Barry CL. Effect of Exposure to Visual Campaigns and Narrative Vignettes on Addiction Stigma Among Health Care Professionals :  A Randomized Clinical Trial .  JAMA Netw Open.  2022;5(2):e2146971. doi:10.1001/jamanetworkope

While the standard of care for pregnant people with opioid use disorder (OUD) is to be on medications for opioid use disorder (MOUD) with methadone or buprenorphine, the PIPS study found that this care is not consistently available, meaning that pregnant people in custody are being forced to go through withdrawal. ARRWIP, Johns Hopkins School of Medicine

Alcohol Research:  Current Reviews v. 42, issue 1, 2022 Marc A. Schuckit "One crucial tool for identifying factors that influence alcohol consumption and its consequences are longitudinal studies that follow individuals over long periods of time, sometimes including evaluating family members over several generations. Among the most important alcohol-related longitudinal studies are the San Diego Prospective Study (SDPS), the Collaborative Study on the Genetics of Alcoholism (COGA) and the Avon Longitudinal Study of Parents and Children (ALSPAC), each of which have been supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This article briefly summarizes some findings from these studies, particularly the SDPS. After reviewing the contribution of genetic and environmental influences in AUD, it will introduce a low level of response (low LR) to alcohol as a risk factor for AUD. The article will then describe the 40-year SDPS in more detail, as well as its main