Addiction Medicine and Addiction Psychiatry Updates

  “The Substance Abuse and Mental Health Services Administration (SAMHSA)  rolled out a new 988 website  designed to serve as your one-stop-shop for 988 resources from SAMHSA.  The site contains a 988 partner toolkit which includes materials designed to cover the basics of 988 and provide a strong foundation from which partners can build for their audience-specific needs. 988 – the easy-to-remember 3-digit code providing  access to life-saving services-  is going live on all devices on July 16, 2022. Visit the website for  key messages ,  FAQs , and  Fact Sheet  to facilitate partner efforts and communication planning.”

Brian S. Barnett MD, Sarah E. Wakeman MD, Corey S. Davis JD, MSPH, Jamie Favaro MSW, and Josiah D. Rich MD, MPH Published Online: May 05, 2021 https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2021.306228 WHAT IS  NEXT DISTRO ? An online and mail-based  harm reduction service  designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.

Current Opinion in Pharmacology Volume 62 , February 2022, Pages 145-151 Abstract:  Alcohol contributes to more than 5% of global mortality, and causes more than half of all liver-related deaths. The Alcohol Use Disorders Identification Test (AUDIT) can be used to detect those patients with hazardous drinking and alcohol dependence who will benefit from psychosocial and pharmacological alcohol treatment. Psychosocial treatments range from brief interventions and cognitive behavioral therapy, to experimental neuropsychological treatments. Psychosocial intervention can be combined with acamprosate or naltrexone as first line pharmacological treatments. For patients with liver disease, abstinence increases survival and is therefore an important treatment goal. Acamprosate is a good choice, as it prevents relapse to drinking with a number needed to treat of 12. There are no reports indicating high risks of liver toxicity for acamprosate or naltrexone, but evidence is scarce. We recommend v

You can hear some of our addiction fellowship faculty on The Addiction Files podcast ! Darlene Petersen MD and Paula Cook MD are board certified addiction medicine and family medicine physicians providing evidence based education, clinical pearls and resources to physicians, residents and students while striving to destigmatize the treatment of addiction in our medical culture and save lives. Tune in to learn about the latest treatments for all things addiction. Join us as we conduct expert interviews, review clinical pearls and best practices and discuss the latest updates in addiction medicine. No explicit language but this podcast discusses the abuse and treatment of legal and illegal drugs and may not be appropriate for all listeners.

March 18, 2022 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790261   Question     What are the risks and benefits of obtaining a medical marijuana card for adults who seek medical marijuana for pain, insomnia, and anxiety or depressive symptoms? Findings    In this randomized clinical trial involving 186 participants, immediate acquisition of a medical marijuana card increased the incidence and severity of cannabis use disorder (CUD) and resulted in no significant improvement in pain, anxiety, or depressive symptoms, but improved self-reported sleep quality. Meaning    Findings from this study suggest the need for further investigation into the benefits of medical marijuana card ownership for insomnia symptoms and the risk of CUD, particularly for those with anxiety or depressive symptoms.

An older reference but an important one!  World Health Organization .  (‎2004)‎.  Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users.  World Health Organization.  https://apps.who.int/iris/handle/10665/43107 This review was authored by Annie Cooney and Alex Wodak. For the full PDF:  https://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf

Presenter(s):   Kathleen Brady, MD, PhD , Distinguished Professor, Medical University of South Carolina Webinar Description:   Exacerbated by the COVID-19 pandemic, the Opioid Epidemic in the United States is a dangerous reality that affects all demographics. In this presentation, gender differences in opioid use disorders will be discussed from an epidemiologic perspective. Understanding the differences in trends by gender can help clinicians treat the patient, rather than treating the condition. Neurobiological and social determinants will also be reviewed as the differences vary greatly by gender. Finally, treatment implications will be discussed so we can better understand the impact of tailored OUD treatment. Educational Objectives: Apply the epidemiologic differences in the prevalence of OUD to your practice setting. Identify the gender differences in neurobiology of OUD when treating patients. Evaluate the patient treatment outcomes based on gender. Look for webinar recording to

In June 2021, the  National Academy of Medicine ,  Dell Medical School at The University of Texas at Austin , and  Shatterproof   hosted the  Stigma of Addiction Summit , an action-oriented summit entirely dedicated to understanding, addressing, and eliminating the harmful impacts of stigma on people who use drugs. The goals were to elevate current efforts at reducing stigma, identify successes and gaps in the evidence base, and prioritize and identify areas for future research and funding with an explicit focus on stigma, which is often touched upon only marginally in broader conversations about addiction. Proceedings and links to presentations now available through the link in the graphic.

  Among patients who have their long-term opioid therapy discontinued or tapered, there is an increased risk of illicit opioid use (Panel A), a high incidence of emergency department visits and opioid-related hospitalizations (Panel B), an increased incidence of mental health crises and overdose events (Panel C), and an increased risk of death from suicide or overdose (Panel D). 𝙸 bars in Panel C indicate 95% confidence intervals. Data are from Coffin et al., 2  Mark and Parish, 3  Agnoli et al., 4  and Oliva et al. 5 https://www.nejm.org/doi/full/10.1056/NEJMp2115244

The National Academies of Sciences Engineering and Medicine  workshop " Methadone Treatment for Opioid Use Disorder: Examining Federal Regulations and Laws " was held March 2-3, 2022.     The workshop brought  together experts and key stakeholders to examine the current federal regulatory and legal landscape regarding provision of and access to methadone for the treatment of opioid use disorder, and focused on the following:  Examine current federal regulations governing methadone treatment services, including the current COVID-19 emergency regulatory relief;  Discuss the impact of these regulations relative to other factors affecting treatment services;  Explore potential options for modifying federal regulations and laws to expand access to quality treatment with methadone; and  Explore state laws that may conflict with federal regulations.  For more information and to access workshop materials:   https://www.nationalacademies.org/event/03-03-2022/methadone-treatment-for-o

  Key Points Question    Was implementation of a benzodiazepine-sparing order set associated with changes in medication use and outcomes for patients hospitalized with alcohol withdrawal syndrome? Findings    In this quality improvement study of 22 899 hospitalizations among 16 323 adults diagnosed with alcohol withdrawal syndrome, order set implementation was associated with relative decreases in benzodiazepine exposure, intensive care unit use, and length of stay. Meaning    The findings of this study suggest that quality improvement initiatives to decrease benzodiazepine use among patients with alcohol withdrawal syndrome may be associated with decreased use of benzodiazepines and positive patient health outcomes. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789264

Nora Volkow, MD, PhD, director of the National Institute on Drug Abuse, spoke at the 2021 Addiction Policy Forum National Leadership Conference.  Watch her presentation on  Drug Use and Addiction:  What Has Science Revealed?

George F Koob, PhD, Director of the National Institute on Alcohol Abuse and Alcoholism, was one of the presenters at the 2021 Addiction Policy Forum.   Watch his presentation here: Alcohol use disorder as a coping response:  Hyperkatifeia, Deaths of Despair and COVID-19

Many of the benefits of microdosing psychedelics may be due to the placebo effect.  https://www.nytimes.com/2022/02/28/well/mind/microdosing-psychedelics.html Studies referenced in this NY Times article::: Psilocybin microdosing does not affect emotion-related symptoms and processing: A preregistered field and lab-based study . Self-blinding citizen science to explore psychedelic microdosing . Repeated low doses of LSD in healthy adults: A placebo-controlled, dose–response study .

From Eric Garland, PhD and other colleagues at the University of Utah: Question     Does a mindfulness-based intervention reduce comorbid chronic pain and opioid misuse in the primary care setting more than supportive psychotherapy? Findings     In this randomized clinical trial that included 250 adults with both chronic pain and opioid misuse, 45.0% of participants receiving Mindfulness-Oriented Recovery Enhancement (MORE) were no longer misusing opioids after 9 months of follow-up compared with 24.4% of participants receiving supportive group psychotherapy. Participants receiving MORE also reported significant improvements in chronic pain symptoms compared with those receiving supportive psychotherapy. Meaning     In this study, MORE appeared to be an efficacious treatment for opioid misuse among adults with chronic pain. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2789279

ASAM 53rd Annual Conference, March 31-April 3, 2022.  Live and in Person in Hollywood, FL.   https://annualconference.asam.org/  ASAM Review Course, July 22-24, 2022, Chicago, IL.  https://reviewcourse.asam.org/  CSAM 2022 State of the Art Addiction Medicine Conference, August 24-27, 2022. San Diego, CA.  https://csam-asam.org/events/csam-2022-state-of-the-art-addiction-medicine-conference/ ASAM State of the Art Course, Fall 2022.   https://stateoftheart.asam.org/ AMERSA Annual Conference, November 10-12, 2022.   https://amersa.org/conference-fees/  AAAP Annual Meeting and Scientific Symposium,  December 8-11, Naples, FL.   https://www.aaap.org/training-events/annual-meeting/2022-annual-meeting/

  Avoid an Overdose Fentanyl use can increase your risk of overdose, especially if you do not regularly use opioids. Fentanyl has been found in many different drugs, including heroin, cocaine, crack, methamphetamine, ketamine and pills from nonmedical sources. Anyone who uses drugs that may contain fentanyl, even occasionally, may be at risk of overdose. To prevent an overdose: Avoid using alone and take turns Start with a small dose and go slowly Keep naloxone ready and on hand Avoid mixing drugs Test your drugs using fentanyl test strips Fentanyl Test Strip Instructional Brochure  (PDF) Other Languages:  Español  |  繁體中文  |  简体中文  |  Русский  |  Kreyòl ayisyen  |  한국어  |  বাংলা  |  Italiano  |  Polski  |  Français  |  ײִדיש  |  العربية  |  اردو Fentanyl Test Strip Instructional Poster  (PDF) https://www1.nyc.gov/site/doh/health/health-topics/fentanyl.page

Summary of  Recommendations Screen all patients for tobacco use disorder Offer evidence-based treatment to all patients with tobacco use disorder Use motivational and harm reduction strategies for patients ambivalent about quitting Implement organizational policies to support treatment of tobacco use disorder https://www.asam.org/quality-care/clinical-guidelines/tobacco