Addiction Medicine and Addiction Psychiatry Updates

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/