Addiction Medicine and Addiction Psychiatry Updates

A drug called buprenorphine may be the best tool doctors have to fight the fentanyl crisis. Why hasn’t it been more widely adopted? https://www.nytimes.com/2025/02/16/magazine/buprenorphine-opioid-addiction-treatment.html

  https://drugabusestatistics.org/ The front page of DrugAbuseStatistics.org features the most noteworthy drug abuse data, including overdose deaths, demographics, mental health, drug abuse treatment programs, and the cost of the War on Drugs.

The agency has Suboxone on its Suspicious Order Reporting System https://www.statnews.com/2024/10/03/opioid-addiction-buprenorphine-dea-monitoring/

Reuters:   A secretive route that drug traffickers use to transport fentanyl-making chemicals from China to Mexico runs straight through the United States. It’s called the “master carton” smuggling scheme, and it all starts with one little box. https://www.reuters.com/investigates/special-report/usa-fentanyl-supply-chain-shipping/

This brochure explains the Federal laws that prohibit discrimination against individuals with disabilities and how they protect people receiving Medication Assisted Treatment for opioid addiction (also known as “MAT”).  MAT includes a medication (e.g., methadone, buprenorphine, oral naltrexone) approved by the U.S. Food and Drug Administration (FDA) for opioid addiction detoxification or maintenance treatment.  https://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/Know-Your-Rights-Brochure.pdf  

The   PATHS toolkit   offers evidence-based educational resources about the use of medication to treat opioid use disorder (OUD) during and after pregnancy. Culturally and linguistically appropriate versions are also available for  American Indians & Alaska Natives  and Spanish speakers (coming soon) . Resources include videos, discussion guides, fact sheets, flyers, posters, and social media messaging.   https://ctnlibrary.org/paths-oud-nida-ctn-di/  

This cohort study in 135,103 older drinkers found that even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. Wine preference and drinking only with meals were associated with attenuating the excess mortality associated with alcohol consumption. Ortolá R ,  Sotos-Prieto M ,  García-Esquinas E ,  Galán I ,  Rodríguez-Artalejo F. Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors.  JAMA Netw Open.  2024;7(8):e2424495. doi:10.1001/jamanetworkopen.2024.24495

Not all patients respond to effective and approved treatment interventions, and there has been growing recognition in the medical field of these “resistant” or refractory illnesses (eg, treatment-resistant depression, resistant hypertension). In the field of substance use disorders, there has not been an explicit acknowledgement of treatment-refractory addiction (TRA) despite substantial evidence that many patients do not respond to standard-of-care treatment interventions. This article provides a justification for TRA as a critically important condition to recognize and define. TRA is not conceptualized as a diagnosis, but as a signal that a current treatment approach has not worked. The article addresses areas in need of research and consensus in order to ensure the approach to TRA is uniform, thoughtfully addressed, and data-driven. By explicitly acknowledging TRA, clinicians, researchers, and patients and their families can begin to explore the unique features of this population an...

Question     What reasons do physicians give for not addressing substance use and addiction in their clinical practice? Findings     In this systematic review of 283 articles, the institutional environment (81.2% of articles) was the most common reason given for physicians not intervening in addiction, followed by lack of skill (73.9%), cognitive capacity (73.5%), and knowledge (71.9%). Meaning     These findings suggest effort should be directed at creating institutional environments that facilitate delivery of evidence-based addiction care while improving access to both education and training opportunities for physicians to practice necessary skills. JAMA Netw Open.  2024;7(7):e2420837. doi:10.1001/jamanetworkopen.2024.20837 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821497  

Question     Is cannabis use associated with increased risk of head and neck cancer (HNC)? Findings    In this cohort study of 116 076 individuals, people with cannabis use disorder had an increased risk of any HNC, as well as oral, oropharyngeal, nasopharyngeal, salivary gland, and laryngeal cancer, compared with a group of matched individuals. Meaning    The results of this study suggest that patients with cannabis-related disorder may be at an increased risk for HNC, and further studies are required to further explore the strength and potential mechanisms of this association. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2822269 Commentary:   https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2822271

Although primary prevention efforts strive to address substance misuse across the lifespan, all too frequently, they focus on youth and young adults. However, it is noteworthy that data show an increase in substance misuse among older adults in the United States. Researchers are warning that this, along with the aging of the population, could create a public health crisis. Speakers walked attendees through the national landscape regarding substance misuse among older adults and provided a clear picture of what the data show. Attendees learned about the special considerations to take into account when working with older adults (e.g., lower tolerance for medication dosage, increased risk for injury, potential for interaction with prescribed medications, how substances can impact chronic health conditions common later in life). They also heard about how to mobilize new partners working with this population.  Learning Objectives:  Identified substance misuse issues impacting older...

Research is sparse and definitions aren't consistent, experts say. " Taking small doses of psychedelics, referred to as "microdosing," has become increasingly popular, but little is known about the safety or efficacy of the trend." https://www.medpagetoday.com/popmedicine/cultureclinic/111085

Eight weeks of acupuncture were superior to sham acupuncture in reducing methadone dose and decreasing opioid craving. Liming Lu, Chen Chen, Yiming Chen, et al.  Effect of Acupuncture for Methadone Reduction : A Randomized Clinical Trial .  Ann Intern Med.   [Epub 9 July 2024]. doi: 10.7326/M23-2721   https://www.acpjournals.org/doi/10.7326/M23-2721

" Roughly 60%  of people who are incarcerated have a substance use disorder, in many cases an opioid use disorder. When people with addiction leave prison or jail and return to their communities, they are at very high risk of returning to drug use and overdosing. Their tolerance to drugs has diminished during incarceration, and fentanyl is pervasive in the street drug supply. Even one relapse could be fatal. It  remains a common belief   that simply stopping someone from taking drugs while in jail or prison is an effective approach to treatment. But that belief is inaccurate and dangerous...." https://www.statnews.com/2024/07/09/providing-addiction-treatment-prisons-jails/

Heroin use disorder in humans and chronic opioid administration to mice result in an increase in the number and a decrease in the size of detected hypocretin (Hcrt, or orexin) neurons. Chronic morphine administration to mice increases Hcrt axonal projections to the ventral tegmental area (VTA), the level of tyrosine hydroxylase (TH) in VTA and the number of detected TH +  cells in VTA, and activates VTA and hypothalamic microglia. Co-administration of morphine with the dual Hcrt receptor antagonist suvorexant prevents morphine-induced changes in the number and size of Hcrt neurons, the increase in Hcrt projections to the VTA and microglial activation in the VTA and hypothalamus. Co-administration of suvorexant with morphine also prevents morphine anticipatory behavior and reduces opioid withdrawal symptoms. However, suvorexant does not diminish morphine analgesia. Here we show that combined administration of opioids and suvorexant may reduce the addiction potential of opioid use fo...

The results indicate that OXR signaling in the pPVT is critical for stress-induced reinstatement of oxycodone seeking, further corroborating OXRs as treatment targets for opioid use disorder. Jessica M Illenberger, Francisco J Flores-Ramirez, Glenn Pascasio, Marissa Franco, Brandon Mendonsa, Rémi Martin-Fardon.  Pivotal role of orexin signaling in the posterior paraventricular nucleus of the thalamus during the stress-induced reinstatement of oxycodone-seeking behavior .   Journal of Psychopharmacology , 2024; DOI:   10.1177/02698811241260989

Risako Fujikawa, Adam I. Ramsaran, Axel Guskjolen, Juan de la Parra, Yi Zou, Andrew J. Mocle, Sheena A. Josselyn, Paul W. Frankland.  Neurogenesis-dependent remodeling of hippocampal circuits reduces PTSD-like behaviors in adult mice .   Molecular Psychiatry , 2024; DOI:   10.1038/s41380-024-02585-7 https://www.sciencedaily.com/releases/2024/05/240520122802.htm

Question     How many children in the US lost a parent to a drug overdose between 2011 and 2021, and does the rate vary by parent age, sex, or race and ethnicity? Findings    In this cross-sectional study from 2011 to 2021, an estimated 321 566 community-dwelling children in the US lost a parent aged 18 to 64 years to drug overdose, and the rate of children who lost a parent to overdose increased during this period. In 2021, the highest rate was found among non-Hispanic American Indian and Alaska Native individuals. Meaning    The findings indicate that responses to the overdose crisis should account for the full burden of overdose on families and children, including addressing the economic, social, educational, and health care needs of children who have lost parents to overdose. Jones CM ,  Zhang K ,  Han B, et al. Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021.  JAMA Psychiatry.  Published o...

The Substance Abuse and Mental Health Services Administration (SAMHSA) has finalized an overhaul of opioid treatment programs (OTPs) that enshrines many flexibilities first implemented during the crisis response to the COVID pandemic. These changes represent the first significant change to methadone treatment in over 20 years. Dr. Olsen returns to the AAAP podcast to talk more about these important policy changes and what providers need to know. Dr. Yngvild Olsen is the director for the Center for Substance Abuse Treatment.   https://soundcloud.com/aaap-podcast/otp-regulations

Data from 281 patients pulled from three prospective cohort studies at the University of New Mexico examined the dose-response effects of mild-to-moderate prenatal alcohol exposure (PAE) and episodic binge drinking on perinatal outcomes. After adjusting for tobacco co-exposure and socio-demographic characteristics, mild-moderate PAE in periconceptional period and during pregnancy, including consumption of as little as ≤1 drink/week, was associated with reduced duration of gestation. Episodic binge drinking was associated with reduced gestation and birth length percentile. Ludmila N. Bakhireva, Xingya Ma, Alexandria Wiesel, Fiona E. Wohrer, Jared DiDomenico, Sandra W. Jacobson, Melissa H. Roberts.  Dose–response effect of prenatal alcohol exposure on perinatal outcomes .   Alcohol, Clinical and Experimental Research , 2024; DOI:   10.1111/acer.15284