Addiction Medicine and Addiction Psychiatry Updates

The expansion of telehealth services during the COVID-19 pandemic was associated with individuals staying in treatment longer and reducing their risk of medically treated overdose, according to a new study:   https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795953   Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic Question:    How were federal emergency authorities to expand telehealth use for substance use disorder treatment and facilitate provision of medications for opioid use disorder (MOUD) used during the COVID-19 pandemic among Medicare beneficiaries with opioid use disorder (OUD)? Findings:    In this cohort study including 175 778 beneficiaries, receipt of OUD-related telehealth services during the COVID-19 pandemic was associated with improved MOUD retention and lower odds of medically treated overdose. Meaning:    Emerge

By Dr. Nora Volkow, National Institute on Drug Abuse  || “…but more research is needed.” That’s often the refrain in science, and it includes addiction research. As the addiction and overdose crises continue to claim an unprecedented number of lives and fray communities, science is an essential part of the solution. In the science-to-medicine pipeline, there is a point when a body of evidence is so well-established that to not put the science into action would be an abdication of responsibility. When it comes to the current crisis, there are at least five things that science has shown conclusively to be effective, where communities and healthcare providers can apply what we already know works. We don’t need to keep asking if these things work. Instead, we must find ways to help providers, people, and communities overcome the barriers to implementing these valuable interventions. 1. Naloxone saves lives. 2. Medications for opioid use disorder can work. 3. Contingency management is an e

International Overdose Awareness Day events around the world, August 31, 2022. Join us Wednesday August 31st 2022 on the South steps of the Utah State Capitol to remember those we've lost, raise awareness and be part of creating positive   change. 7:00pm - 8:30pm https://www.facebook.com/OverdoseAwarenessUtah/ Two Minutes of Silence-- One Minute to Remember One Minute to Give Hope

Overdose Awareness Day: Remember. Act. Main page content Date:  August 31, 2022  By:  Chase Holleman, LCSW, LCAS, Public Health Advisor, Center for Substance Abuse Prevention August 31, 2022, is International Overdose Awareness Day, and we pause to honor those who have died from an overdose and to reflect on the grief of those they left behind. Many continue to live with the stigma associated with having a close family or friend die from an overdose. Overdose is the leading cause of death for people ages 18 to 45 in America today.  More than 100,000 people died of an overdose  in the United States in the 12-month period ending in March 2022.  1   Many of us know one of the 100,000, some of us know more than one, and some of us may know dozens. Among this group are our children, siblings, parents, grandparents, cousins, non-blood relatives, and friends. For many, the observance on August 31 might be the first and only time to share their grief without stigma. International Overdose Awar

JAMA Psychiatry.  Published online August 24, 2022. doi:10.1001/jamapsychiatry.2022.2096 Question:    Does psilocybin-assisted treatment improve drinking outcomes in patients with alcohol use disorder relative to outcomes observed with active placebo medication? Findings:    In this double-blind randomized clinical trial with 93 participants, the percentage of heavy drinking days during 32 weeks of follow-up was significantly lower in the psilocybin group than in the diphenhydramine group. Meaning:   The results in this trial showed that psilocybin administered in combination with psychotherapy produced robust decreases in the percentage of heavy drinking days compared with those produced by active placebo and psychotherapy.

New findings from the ABCD study: JAMA Netw Open.  2022;5(8):e2225991. doi:10.1001/jamanetworkopen.2022.25991 | Question:     How is initiation of tobacco use, including electronic cigarettes, cigarettes, and other tobacco products, at an early age associated with children’s neurocognitive functions? | Findings:     In this national cohort study of 17 073 children with neuroimaging outcomes, a significant association was found of early-age initiation of tobacco use with lower crystalized cognition composite score and impaired brain development in total cortical area and volume. Region of interest analysis also revealed smaller cortical area and volume across frontal, parietal, and temporal lobes. | Meaning:     These findings suggest that initiation of tobacco use is associated with inferior neurocognitive functions ; evidence-based intervention strategies and tobacco control policies should prevent tobacco initiation at a young age.

Marijuana and hallucinogen use among young adults reached all time-high in 2021 | National Institute on Drug Abuse (NIDA) (nih.gov)   | August 22, 2022  | Marijuana and hallucinogen use in the past year reported by young adults 19 to 30 years old increased significantly in 2021 compared to five and 10 years ago, reaching historic highs in this age group since 1988, according to the Monitoring the Future (MTF) panel study. Rates of past-month nicotine vaping, which have been gradually increasing in young adults for the past four years, also continued their general upward trend in 2021, despite leveling off in 2020. Past-month marijuana vaping, which had significantly decreased in 2020, rebounded to pre-pandemic levels in 2021. Alcohol remains the most used substance among adults in the study, though past-year, past-month, and daily drinking have been decreasing over the past decade. Binge drinking (five or more drinks in a row in the past two weeks) rebounded in 2021 from a historic low

University of Minnesota. Study finds that sound plus electrical body stimulation has potential to treat chronic pain: New technique could relieve pain for individuals with various chronic and neurological conditions. ScienceDaily. ScienceDaily, 11 August 2022. www.sciencedaily.com/releases/2022/08/220811083335.htm .   Cory D Gloeckner, Jian C Nocon, Hubert H Lim.  Topographic and widespread auditory modulation of the somatosensory cortex: potential for bimodal sound and body stimulation for pain treatment .   Journal of Neural Engineering , 2022; 19 (3): 036043 DOI:   10.1088/1741-2552/ac7665

  https://pubmed.ncbi.nlm.nih.gov/35749758/ Lemborexant (LEM) is a dual orexin receptor antagonist approved for the treatment of insomnia in adults in multiple countries including the United States, Japan, Canada, Australia and several Asian countries. Conclusions:  For all doses, LEM demonstrated abuse potential versus PBO and appeared to have a similar abuse potential profile to Zolpidem (ZOL) and Suvorexant (SUV) in this study population. Lemborexant was well tolerated. Lemborexant has been placed in Schedule IV, the same drug schedule as ZOL and SUV.

Joseph B. Williams  summarizes the legal regulation of opioid use disorder medications in the United States.  Short, pithy and very helpful! Academic Psychiatry   volume  46 ,  pages 405–406 ( 2022 )   https://link.springer.com/article/10.1007/s40596-021-01522-y

Helping Your Patients with Alcohol-Related Problems What to know, ask, and offer Alcohol contributes to more than 200 health conditions and about 99,000 deaths in the U.S. each year. Yet alcohol-related risks often go unaddressed in healthcare settings.  The Core Resource on Alcohol provides evidence-based content to help healthcare professionals: Gain new insights—and earn FREE CME or CE credit —with  14 articles  on alcohol and health covering basic principles, clinical impacts, and patient care from screening through recovery. Overcome barriers to care for patients with alcohol problems —by filling training gaps for providers who are not addiction specialists, including ways to counteract patient stigma. "This resource is a good way to  increase your confidence when you see patients with alcohol-related concerns , which you're going to see often."  — Primary care practitioner Learn more about the Core Resource on Alcohol

Supervised Injection Facilities: slides for medical education.   Society for the Study of Addiction. This is the first in a series of slides designed for use in medical education as well as for all people interested in addiction. This slide set covers Supervised Injection Facilities, and has been designed in collaboration with  Drug Science.

The US opioid crisis has evolved over time.  Wave 1, in approximately 2000, was prompted by doctors overprescribing opioid painkillers, which was associated with mass addiction. Wave 2 involved heroin; OODs from heroin escalated in 2007 and surpassed those from prescription opioids by 2015. Wave 3 involved illicit synthetic opioids, such as fentanyl, the use of which escalated after 2013. Further evidence suggests a fourth wave, complicated by the addition of stimulants and the COVID-19 pandemic. To inform prevention and mitigation strategies, this cross-sectional study examined trends in OOD rates in urban and rural US counties during the 4 waves.   JAMA Netw Open.  2022;5(7):e2223631. doi:10.1001/jamanetworkopen.2022.23631  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794742

Study identifies new links between REM sleep disturbances and drug relapse: Hypothalamic MCH neurons may be a treatment target, report researchers https://www.sciencedaily.com/releases/2022/07/220726132617.htm Relapse presents a major barrier to recovery from substance use disorders -- when people begin taking drugs such as cocaine again after a period of abstinence. Sleep disruptions have long been associated with drug withdrawal and relapse. Now, a new study provides a more detailed picture of recovery-related sleep that could lead to insights for better recovery treatments.

Psychiatric News, August 3, 2022:   The number of individuals prescribed buprenorphine for opioid use disorder (OUD) during the first year of the COVID-19 pandemic increased steadily after the federal government instituted policies that allowed for greater use of telehealth, according to a  report  in  AJP in Advance .

  Association of cannabis potency with mental ill health and addiction: a systematic review     RSS     Download PDF Kat Petrilli  MRes ,  Shelan Ofori  MRes ,  Lindsey Hines  PhD ,  Gemma Taylor  PhD ,  Sally Adams  PhD  and  Tom P Freeman  PhD Lancet Psychiatry, The, Copyright © 2022 Elsevier Ltd   Open reading mode Summary Cannabis potency, defined as the concentration of Δ  9 -tetrahydrocannabinol (THC), has increased internationally, which could increase the risk of adverse health outcomes for cannabis users. We present, to our knowledge, the first systematic review of the association of cannabis potency with mental health and addiction (PROSPERO, CRD42021226447). We searched Embase, PsycINFO, and MEDLINE (from database inception to Jan 14, 2021). Included studies were observational studies of human participants comparing the association of high-potency cannabis (products with a higher concentration of THC) and low-potency cannabis (products with a lower concentration of THC), as

Medication prescribing for alcohol use disorders during alcohol-related encounters in a Colorado regional healthcare system Rationale:  Investigations show that medications for alcohol use disorders (MAUD) reduce heavy drinking and relapses. However, only 1.6% of individuals with alcohol use disorders (AUD) receive MAUD across care settings. The epidemiology of MAUD prescribing in the acute care setting is incompletely described. We hypothesized that MAUD would be under prescribed in inpatient acute care hospital settings compared to the outpatient, emergency department (ED), and inpatient substance use treatment settings. Methods:  We evaluated electronic health record (EHR) data from adult patients with an International Classification of Diseases, 10th revision (ICD-10) alcohol-related diagnosis in the University of Colorado Health (UCHealth) system between January 1, 2016 and 31 December, 2019. Data from patients with an ICD-10 diagnosis code for opioid use disorder and those receiv