Facilitators of and barriers to buprenorphine initiation in the emergency department: a scoping review The Lancet Regional Health Americas In the context of the opioid overdose epidemic, great efforts have been made to increase access to medication for opioid use disorder (MOUD), specifically buprenorphine. Initiation of buprenorphine in emergency departments (ED) has been a focus of these efforts. While initiation has been increasing, only 3-15% of persons treated in EDs fill a prescription. In...
Oct 15, 2024•7 min•Ep. 138
Cannabis Policy Impacts Public Health and Health Equity National Academy of Sciences Engineering Medicine This report from the National Academies of Sciences, Engineering, and Medicine urges the federal government to provide policy guidance to states that have legalized cannabis, close regulatory loopholes on intoxicating products derived from hemp, and create a public health campaign aimed at parents and vulnerable populations, among other measures that would protect public health and reduce th...
Oct 08, 2024•6 min•Ep. 137
In this episode recorded live at ASAM's 55th Annual Conference in Fort Worth, TX, host Dr. Nick Athanasiou sat down with Dr. Shannon Miller to discuss his work on PAM-7, and his path to addiction medicine. Subscribe to the ASAM Weekly
Sep 30, 2024•21 min•Ep. 135
Risk of Incident Psychosis and Mania With Prescription Amphetamines The American Journal of Psychiatry This case-control study used electronic health records to examine the impact of dose levels of prescription amphetamines on the risk of incident psychosis and mania with prescription amphetamines. Among 1,374 case subjects and 2,748 control subjects, the odds of psychosis and mania were increased for individuals with past-month prescription amphetamine use compared with no use. A dose-response ...
Sep 24, 2024•7 min•Ep. 134
Cannabis Laws and Utilization of Medications for the Treatment of Mental Health Disorders 🔓 JAMA Network Open This cross-sectional study of 9,438,716 commercially insured patients examined if access to cannabis, via medical or recreational legalization, is associated with changes in the dispensing of prescription medications to treat mental health disorders. Researchers found statistically significant reductions in benzodiazepine dispensing after increases in both medical and recreational canna...
Sep 17, 2024•6 min•Ep. 133
State-level racial and ethnic disparities in buprenorphine treatment duration in the United States The American Journal on Addictions National trends reveal a concerning escalation in racial and ethnic disparities in buprenorphine treatment duration for opioid use disorder. This study examined such disparities at the state level. Analyzing 9,040,620 buprenorphine prescriptions dispensed between January 2011 and December 2020 from IQVIA Longitudinal Prescription data, the study revealed substanti...
Sep 10, 2024•5 min•Ep. 132
Virtual reality-based Mindfulness-Oriented Recovery Enhancement (MORE-VR) as an adjunct to medications for opioid use disorder: a Phase 1 trial 🔓 Annals of Medicine Mindfulness-Oriented Recovery Enhancement (MORE) uses mindfulness training to address dysregulation in brain reward systems. MORE has been shown to reduce drug cue reactivity and in an RCT reduced opioid misuse 45% at 9 months. Face-to-face MORE requires significant time of trained clinicians, and this study explored the feasibility...
Sep 04, 2024•6 min•Ep. 131
The Lancet Psychiatry Commission on youth mental health 🔓 The Lancet Psychiatry Mental ill health, which has been the leading health and social issue impacting the lives and futures of young people for decades, has entered a dangerous phase. Accumulating research evidence indicates that in many countries, the mental health of emerging adults has been declining steadily over the past two decades, with a major surge of mental ill health driven by the COVID-19 pandemic, the measures taken to conta...
Aug 27, 2024•6 min•Ep. 130
Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors JAMA Network Open This British study included 135,103 older (median age 64) adults and compared drinking patterns with mortality during a median follow-up of 12 years. Compared to occasional drinkers, low-risk drinkers had higher cancer mortality (HR, 1.11), moderate-risk drinkers had higher all-cause and cancer mortality (HRs, 1.10 and 1.15), and high-risk drinking had higher all-caus...
Aug 20, 2024•5 min•Ep. 129
Physician Reluctance to Intervene in Addiction: A Systematic Review JAMA Network Open This systematic review of 283 articles explored the reasons physicians give for not addressing substance use and addiction in their clinical practice. 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%). These findings suggest that efforts should be dir...
Aug 13, 2024•5 min•Ep. 128
Host Dr. Nick Athanasiou sat down with Drs. Matisyahu Shulman and Adam Bisaga to discuss the study they recently authored titled Rapid Initiation of Injection Naltrexone for Opioid Use Disorder: A Stepped-Wedge Cluster Randomized Trial. The doctors share their findings and the impact and implications of the study. Subscribe to The ASAM Weekly to read the guest editorial: Guest Editorial: Rapid Initiation of Injectable Extended-Release Naltrexone for Opioid Use Disorder: A Time for Paradigm Shift...
Aug 06, 2024•32 min•Ep. 127
Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders JAMA Psychiatry This is a survey study of 4,674 participants from US households that examined the association between social vulnerability and mental health and substance use disorders and related treatment in the US noninstitutionalized population of adults aged 18 years and older. Large increases in several mental health and substance use disorders and corresponding decreases in treatment were found...
Aug 06, 2024•4 min•Ep. 126
Psilocybin desynchronizes the human brain Nature To assess how human brain network changes relate to the subjective and lasting effects of psychedelics, this study tracked individual-specific brain changes with longitudinal precision functional mapping (roughly 18 magnetic resonance imaging visits per participant). Psilocybin massively disrupted functional connectivity (FC) in the cortex and subcortex, acutely causing more than threefold greater change than methylphenidate. These FC changes were...
Jul 30, 2024•5 min•Ep. 125
Secondhand Nicotine Absorption From E-Cigarette Vapor vs Tobacco Smoke in Children JAMA Network Open This cross-sectional study of 1,777 US children aged 3 to 11 years examined how children’s nicotine absorption, as indexed by serum cotinine level, differ among those exposed to (1) secondhand tobacco smoke only, (2) secondhand e-cigarette vapor only, or (3) neither. Compared with children exposed to secondhand smoke only, nicotine absorption was 83.6% lower in those exposed to secondhand vapor o...
Jul 23, 2024•5 min•Ep. 124
Benzodiazepine use in relation to long-term dementia risk and imaging markers of neurodegeneration: a population-based study 🔓 BMC Medicine This study examined the relationship between benzodiazepine (BZD) use and dementia, using data from the population-based Rotterdam (Netherlands) study started in 1990. For 5,443 participants, BZD use during the 15 years from 1990 to 2005 was compared to dementia screens performed through 2020. Half of the participants had used BZD at some time during the 15...
Jul 16, 2024•5 min•Ep. 123
Extended-release ketamine tablets for treatment-resistant depression: a randomized placebo-controlled phase 2 trial Nature Medicine The safety and tolerability of racemic ketamine may be improved if given orally, as an extended-release tablet (R-107), compared with other routes of administration. In this phase 2 multicenter clinical trial, male and female adult patients with treatment-resistant major depression (TRD) and Montgomery–Asberg Depression Rating Scale (MADRS) scores ≥20 received open-...
Jul 09, 2024•6 min•Ep. 122
Global status report on alcohol and health and treatment of substance use disorders World Health Organization This report utilizes data from the WHO member states to summarize alcohol consumption, its health consequences, and alcohol policies around the world. Overall, there was a decrease in alcohol consumption between 2010 and 2019, but alcohol-related deaths still accounted for 4.7% of all deaths in 2019. Despite the burden, there are still significant gaps in access to and types of treatment...
Jul 02, 2024•5 min•Ep. 121
Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths The New England Journal of Medicine HEALing (Helping to End Addiction Long-term Initiative) Communities Study (HCS) investigators examined the potential of the community-engaged, data-driven Communities That HEAL (CTH) intervention to reduce the rate of opioid-related overdose deaths in highly affected communities. Intervention communities implemented hundreds of strategies to expand opioid overdose education and naloxone ...
Jun 25, 2024•6 min•Ep. 120
Piloting a Hospital-Based Rapid Methadone Initiation Protocol for Fentanyl Journal of Addiction Medicine The epidemic of fentanyl has led to increased opioid tolerance and made traditional dosing for methadone initiation insufficient. In this study, the authors examine an inpatient rapid titration of methadone initiation among patients with opioid use disorder (OUD). The protocol recommended dosing of 60 mg on day 1, 70 mg day 2, 80 mg day 3 and 100 mg day 4-7. After patients with significant un...
Jun 18, 2024•6 min•Ep. 119
Associations of semaglutide with incidence and recurrence of alcohol use disorder in real-world population Nature Communications In this retrospective cohort study of patients receiving medication for treatment of obesity, the authors evaluated the association of semaglutide with incidence of and recurrence of alcohol use disorder (AUD). In the cohort patients received semaglutide or non-GLP1RA medications, including naltrexone and topiramate. In matched cohort analysis, patients who received se...
Jun 11, 2024•6 min•Ep. 118
Innovation and adaptation: The rise of a fentanyl smoking culture in San Francisco Plos One This is a qualitative study describing the growing practice in the San Francisco area of smoking rather than injecting fentanyl. Fentanyl salts are stable up to 350°C making heating and inhalation more effective than for heroin. Some of the increase in smoking is driven by users’ difficulty finding accessible veins. There is also the perception that smoking presents less of a risk of overdose compared to ...
Jun 04, 2024•6 min•Ep. 117
Rapid Initiation of Injection Naltrexone for Opioid Use Disorder JAMA Network Standard initiation procedures (SP) for extended-release (XR)-naltrexone can be a barrier to initiation for patients. In this stepped-wedge cluster-randomized trial, they compared SP initiation (3-5 days buprenorphine taper, 7-10 days opioid-free) to a rapid procedure (RP) initiation (1 day buprenorphine, 1 day opioid free, 3-4 days ascending dose of oral naltrexone). Patients in the RP group (62.7%) were more likely t...
May 28, 2024•6 min•Ep. 116
Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment JAMA Psychiatry Studies have demonstrated that childhood maltreatment is strongly associated with mental health conditions, but this study uses a quasi-experimental design and meta-analysis to assess proportion of various mental health issues that are attributed to childhood maltreatment. The authors found that approximately 25% of mental health disorders (anxiety, depression, alcohol use disorder (AUD), substance use ...
May 21, 2024•6 min•Ep. 115
Associations of cannabis use, use frequency, and cannabis use disorder with violent behavior among young adults in the United States International Journal of Drug Policy An association between cannabis use and violent behavior has previously been reported, so the authors used the 2015-2019 National Survey on Drug Use and Health to better explore this association. In adjusted models, the authors found an increased prevalence of violent behavior among males reporting daily cannabis use with and wi...
May 14, 2024•6 min•Ep. 114
Lead Story Biomarkers of metal exposure in adolescent e-cigarette users: correlations with vaping frequency and flavouring Tobacco Control Various metals have been identified in e-cigarettes and, as their use among youth has increased in the last decade, this is of public health concern. In this study, researchers utilized a national sample of youth who use e-cigarettes and associated between lead, cadmium, and uranium levels and use patterns. Youth who reported intermittent or frequent use had ...
May 07, 2024•5 min•Ep. 113
Association of regular opioid use with incident dementia and neuroimaging markers of brain health in chronic pain patients: analysis of UK Biobank The American Journal of Geriatric Psychiatry In this cohort study, researchers examine the association between regular opioid use in patients with chronic pain and development of dementia over 15 years of follow-up. Regular opioid use versus non-opioid analgesic use in this population was associated with increased risk of incident dementia (HR=1.18 CL...
Apr 30, 2024•6 min•Ep. 112
Preventing deaths after prison release The Lancet Formerly incarcerated people have exceptionally poor health profiles and are at increased risk of preventable mortality when compared to their general population peers. This accompanying editorial discusses a study by Borschmann et al published in the same issue of The Lancet. Using administrative data from the multi-national Mortality After Release from Incarceration Consortium (MARIC) study, the authors examined mortality outcomes for 1,471,526...
Apr 23, 2024•7 min•Ep. 111
Lead Story: Telling the story of the opioid crisis: A narrative analysis of the TV series Dopesick PLOS One Dopesick (2021) is the first TV series whose plot deals exclusively with the opioid crisis in the United States. The current study uses narrative analysis and framing theory to explore this series, discussing its portrayal of the people and themes involved in the opioid crisis. This analysis found that although Dopesick attempts to portray multiple dimensions of the opioid crisis, its narr...
Apr 16, 2024•6 min•Ep. 110
Lead Story: Impact of jail-based methadone or buprenorphine treatment on non-fatal opioid overdose after incarceration Drug and Alcohol Dependence The authors studied the effect of receiving MOUD during incarceration in New York City jails on non-fatal overdose events during the year after discharge. Data were analyzed for patients with OUD incarcerated between 2011-2017 who either received MOUD during the 3 days before release (n=8660) or did not receive MOUD just prior to release (n=10,163). A...
Apr 09, 2024•7 min•Ep. 109
Lead Story: Epigenome-wide association study on methamphetamine dependence Addiction Biology The authors of this study postulate that some of the biologic changes resulting from methamphetamine use may be associated with epigenetic changes from DNA methylation. Such associations have been seen in schizophrenia, mood disorder, obsessive-compulsive disorder, and Parkinson’s disease. Subjects with methamphetamine dependence (n=24) as well as age and sex matched controls had an epigenome-wide analys...
Apr 02, 2024•6 min•Ep. 108
