Addiction Medicine and Addiction Psychiatry Updates

Fentanyl and Xylazine are transforming the opioid epidemic.   https://kffhealthnews.org/news/article/overdose-opioid-use-disorder-synthetic-drugs/

Question     Are there differences in the temporal pattern, presentation, or outcomes for drug-specific etiology of out-of-hospital cardiac arrest (OHCA) due to overdose (OD)? Findings    In a population-based cohort study of 6790 adult patients with emergency medical services–treated OHCA from a US metropolitan system, the incidence of OD-OHCA more than doubled from January 1, 2015, to December 31, 2021, compared with the incidence of non-OD OHCA (ie, no significant change); OHCA due to combined opioid-stimulant etiology experienced the lowest survival among drug-specific profiles. Meaning    The combination of increasing incidence and lower survival among OHCA secondary to combined opioid-stimulant substance use frames an urgent need for prevention and resuscitation strategies in this population. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2811464   Yogeswaran V ,  Drucker C ,  Kume K, et al. Presentation and Outcomes of Adults With Overdose-Related Out-of-Hospital C

Massive genetic study finds genes linked to cannabis addiction  https://www.nature.com/articles/d41586-023-03629-8 Levey, D.F., Galimberti, M., Deak, J.D.  et al.  Multi-ancestry genome-wide association study of cannabis use disorder yields insight into disease biology and public health implications.  Nat Genet  (2023).   https://www.nature.com/articles/s41588-023-01563-z

The National Survey on Drug Use and Health (NSDUH), conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides nationally representative data on the use of tobacco, alcohol, and drugs; substance use disorders; mental health issues; and receipt of substance use and mental health treatment among the civilian, noninstitutionalized population aged 12 or older in the United States. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. All the details available here: https://www.samhsa.gov/data/release/2022-national-survey-drug-use-and-health-nsduh-releases   https://www.samhsa.gov/data/report/2022-nsduh-infographic

Developed by AAAP and ASAM, this guideline focuses on the identification, diagnosis, treatment, and promotion of recovery for patients with stimulant use disorder, stimulant intoxication, and stimulant withdrawal. https://www.asam.org/quality-care/clinical-guidelines/stimulant-use-disorders https://www.aaap.org/education/management-of-stimulant-use-disorder-guideline/

Abstract:  " The faster a drug enters the brain, the greater its addictive potential, yet the brain circuits underlying the rate dependency to drug reward remain unresolved. With simultaneous PET-fMRI we linked dynamics of dopamine signaling, brain activity/connectivity, and self-reported ‘high’ in 20 adults receiving methylphenidate orally (results in slow delivery) and intravenously (results in fast delivery) (trial NCT03326245). We estimated speed of striatal dopamine increases to oral and IV methylphenidate and then tested where brain activity was associated with slow and fast dopamine dynamics (primary endpoint). We then tested whether these brain circuits were temporally associated with individual ‘high’ ratings to methylphenidate (secondary endpoint). A corticostriatal circuit comprising the dorsal anterior cingulate cortex and insula and their connections with dorsal caudate was activated by fast (but not slow) dopamine increases and paralleled ‘high’ ratings. These data p