Addiction Medicine and Addiction Psychiatry Updates

  New SAMHSA publication: This guide focuses on research supporting adaptations of evidence-based practices (EBPs) for under-resourced populations. Adaptations involve tailoring care, programs, and services to the cultural, social, gender, and demographic contexts of the people served to yield positive outcomes. Publication ID PEP22-06-02-004 Publication Date September 2022

...A Cox proportional hazards model indicated that elevated salivary cortisol (with increases in   μ g/dl), marital/relationship status, and adverse childhood experiences (ACEs) score correlated significantly with hazards of discontinuing the program (hazard ratios for the three factors were 3.49, 2.39, and 1.50, respectively). Discussion Cortisol level may predict, at least partially, SUD treatment program retention regardless of individuals' numerous confounding factors or the substance used. If this approach is validated, it could enable providers to consider patients' cortisol levels at the time of admission to treatment to facilitate their retention in treatment and thereby enhance their recovery. Intake assessments of salivary cortisol, survey responses, and adverse childhood experiences are associated with recovery success in an abstinence-based treatment program for substance use disorders Taylor R. Maddox-Rooper , Kristiana Sklioutouskaya-Lopez , Trenton Sturgill , Ca...

Xylazine and Overdoses: Trends, Concerns, and Recommendations Xylazine is a nonopioid veterinary anesthetic and sedative that is increasingly detected in the illicit drug supply in the United States. Data indicate a striking prevalence of xylazine among opioid-involved overdose deaths. The emergence of xylazine in the illicit drug supply poses many unknowns and potential risks for people who use drugs. The public health system needs to respond by increasing testing to determine the prevalence of xylazine, identifying its potential toxicity at various exposure levels, and taking mitigating action to prevent harms. Currently, there is little testing capable of identifying xylazine in drug supplies, which limits the possibility of public health intervention, implementation of harm reduction strategies, or development of novel treatment strategies. ( Am J Public Health . 2022;112(8):1212-1216. https://doi.org/10.2105/AJPH.2022.306881 ).

Spironolactone as a potential new pharmacotherapy for alcohol use disorder: convergent evidence from rodent and human studies Evidence suggests that spironolactone, a nonselective mineralocorticoid receptor (MR) antagonist, modulates alcohol seeking and consumption. Therefore, spironolactone may represent a novel pharmacotherapy for alcohol use disorder (AUD). In this study, we tested the effects of spironolactone in a mouse model of alcohol drinking (drinking-in-the-dark) and in a rat model of alcohol dependence (vapor exposure). We also einvestigated the association between spironolactone receipt for at least 60 continuous days and change in self-reported alcohol consumption, using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), in a pharmacoepidemiologic cohort study in the largest integrated healthcare system in the US. Spironolactone dose-dependently reduced the intake of sweetened or unsweetened alcohol solutions in male and female mice. No effects of spirono...

Single-dose ethanol intoxication causes acute and lasting neuronal changes in the brain .  Proceedings of the National Academy of Sciences , 2022; 119 (25) DOI:  10.1073/pnas.2122477119   To better understand the changes in the brain that support the transition from sporadic drinking to chronic alcohol abuse, we identified distinct effects of single ethanol exposure on a molecular, cellular, and behavioral level. Similar to learning and memory processes, the idea was to discover lasting changes that could mediate lasting ethanol reward memories. By imaging the brains of acutely exposed mice, we found that ethanol induced lasting changes in synaptic morphology, the axon initial segment, and mitochondrial trafficking. In  Drosophila  flies, specific knockdown of mitochondrial trafficking abolished positive ethanol reward memories. Together, our data suggest that a single ethanol exposure induces plastic changes which in turn could contribute to the basis of ethano...

Surveillance System for Opioid-Associated Amnestic Syndrome Creator : Shawn McNeil, MD Duration : 18:09 Journal of Addiction Medicine    Journal of Addiction Medicine. ():10.1097/ADM.0000000000000994, In episode twenty-four of Addiction Medicine: Beyond the Abstract, host Shawn McNeil, MD is joined by Dr. Jed Barash, a Neurologist from Massachusetts. In his paper, Dr. Barash and his colleagues discuss using an existing syndromic surveillance system to monitor for possible cases of opioid-associated amnestic syndrome in the state of Massachusetts. Check out the Podcast series, Addiction Medicine Beyond the Abstract.