This Week in Addiction Medicine from ASAM

Very Low Nicotine Content Cigarettes for Smoking Cessation: Examining a Facilitated Extinction Approach and Dosing Schedule

Drug and Alcohol Dependence

Very low nicotine cigarettes (VLNC, 0.4 mg nicotine/g tobacco) have been shown to reduce smoking behavior when compared to normal nicotine cigarettes (NNC,17 mg nicotine/g tobacco). Participants (n=208) were randomly assigned to 4 experimental groups, immediate versus gradual (over ...

Fatal Opioid Overdoses by Historical and Contemporary Neighborhood-Level Structural Racism🔓

JAMA Health Forum 

This cross-sectional study of 796 census tracts prior to the COVID-19 pandemic (2017-2019) and 792 census tracts during the COVID-19 pandemic (2020-2022) in Chicago, Illinois, assessed the extent to which there is a spatial association between neighborhood-level structural racism and opioid-involved overdose deaths. Resea...

State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015–23

Health Affairs

While medications for opioid use disorder (MOUD) is effective treatment, most patients with OUD don’t receive it and prior authorization (PA) has been a barrier to access. Researchers looked at state policies trying to address this barrier, specifically for private health insurance, between 2015 and 2022. S...

Rapid vs Standard Induction to Injectable Extended-Release Buprenorphine

JAMA Network

This industry-sponsored, multicenter, open-label randomized clinical trial with 729 participants, assessed if  rapid induction (RI) for initiating extended-release buprenorphine is as safe and effective as standard induction (SI) in individuals who inject opioids or use fentanyl.  RI was well tolerated and had higher retention than SI at extended-...

States With Substantial Increases In Buprenorphine Uptake Did So With Increased Medicaid Prescribing, 2018–24

Health Affairs

Multiple federal policy changes since 2018 intended to increase buprenorphine prescribing in response to a persistent treatment gap for opioid use disorder (OUD) in the US. Anticipated national increases did not occur, but highly variable state-level trends provide important insights. This study used IQVIA da...

Ultra-processed food addiction in a nationally representative sample of older adults in the USA 

Addiction

Using a cross-sectional online and telephone survey of a nationally representative sample of older adults (aged 50–80 years) in the US, this study examined the prevalence of ultra-processed food addiction (UPFA) in older US adults and its association with various health domains.  It found that ultra-processed food addiction ap...

Alcohol Consumption Per Capita and Suicide: A Meta-Analysis

JAMA Network Open 

This meta-analysis that included 13 studies assessed if alcohol consumption per capita is associated with suicide mortality and, if so, does the association differ by sex. Researchers found that a 1-L increase in alcohol consumption per capita was associated with a 3.59% increase in the suicide mortality rate. There was no evidence of a sex difference in...

Measures of General Intelligence and Risk for Alcohol Use Disorder

JAMA Psychiatry

This male Swedish cohort study that included 573,855 participants assessed if there is an association between IQ and risk for alcohol use disorder, and if so, what is the nature of this association.  It found that IQ at age 18 years was associated with subsequent alcohol use disorder risk. Mendelian randomization analyses suggest a causal association...

Medications for Opioid Use Disorder Playbook

Agency for Healthcare Research and Quality (AHRQ) 

The AHRQ Integration Academy developed the Medications for Opioid Use Disorder Playbook as a practical guide for providing medications for opioid use disorder (MOUD) and immediate care for patients with OUD in primary care and other ambulatory care settings. It is interactive, web-based, and has the latest guidance, tools, resources, and...

Cannabis Use During Pregnancy and Lactation

American College of Obstetricians & Gynecologists

Cannabis is the most commonly used illicit drug under U.S. federal law. With increasing social acceptability, accessibility, and legalization in many states, the prevalence of cannabis use among pregnant and lactating individuals has increased significantly. Substance use in pregnancy, including cannabis use, has been associated with a...

Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study

American Journal of Psychiatry

This national retrospective cohort study found that veterans with stimulant use disorder who received contingency management (CM) were 41% less likely to die in the year following treatment initiation relative to matched comparison subjects. These findings provide the strongest real-world evidence to date ...

Machine learning– and multilayer molecular network–assisted screening hunts fentanyl compounds

Science Advances

Fentanyl and its analogs are a global concern, making their accurate identification essential for public health. This article introduces Fentanyl-Hunter, a screening platform that uses a machine learning classifier and multilayer molecular network that covers more than 87% of known fentanyls to select and annotate fentany...

Evaluation of a Novel Patient-Centered Methadone Restart Protocol 🔓

JAMA Network Open

Restarting methadone for patients who have had a gap in treatment is often a frustratingly slow process for both the patient and provider. This cohort study of individuals examined outcomes for patients of a public, safety-net opioid treatment program before (n=786 patients) and after (n=780 patients) implementation of a 2022 clinical protocol fo...

Recommendations for Addressing In-Hospital Substance Use From a National Delphi Consensus Process

JAMA Network Open

This survey study utilized a 3-round Delphi consensus process to identify best practices for addressing in-hospital substance use. A panel of 38 addiction experts developed 84 consensus-based and patient-centered recommendations which can inform local responses, including policies, to address in-hospital substance use...

Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting 

JAMA Network Open 

Injectable-only buprenorphine protocols are an exciting new strategy for buprenorphine initiation, particularly in the fentanyl era. This is a cohort study of 95 patients with moderate to severe opioid use disorder who received care in a low-threshold setting in Seattle. 79% of patients included in the study were experiencing ...

Association between housing status and mental health and substance use severity among individuals with opioid use disorder and co-occurring depression and/or PTSD 

BMC Primary Care 

This is a cross-sectional analysis of associations between housing status and mental health and substance use severity among primary care patients with co-occurring disorders. The study is a sub-analysis using data from the Collaboration Leading to Addi...

Oral methadone versus sublingual buprenorphine for the treatment of acute opioid withdrawal: A triple-blind, double-dummy, randomized control trial 

Drug and Alcohol Dependence Researchers compared oral methadone to sublingual buprenorphine for the management of acute opioid withdrawal. Patients at an inpatient drug treatment center in India were randomly assigned to receive either methadone or buprenorphine titrated over days 1-3...

Implementation Gaps in US Syringe Service Programs, 2022 

JAMA  This study performed a cross-sectional analysis of the Syringe Services Programs in the US (SSPUS) dataset to determine implementation gaps. 613 syringe service programs (SSPs) included in the dataset were geocoded to county boundaries, which were then analyzed for urbanicity and SSP need (based on HCV mortality, HIV incidence, and drug overdose mortality). The study ...

Co-involvement of stimulants with opioids in North America: A 'silent epidemic’

Plos Mental Health

The opioid epidemic unfolded in three distinct waves, with the latest being deaths attributed to illegally manufactured synthetic opioids. Using U.S. and Canadian data, this study reviews evidence for a 'silent epidemic' alongside the opioid epidemic that is characterized by the co-ingestion of stimulants including methamphetamine and...