This Week in Addiction Medicine from ASAM

Lead: Memory function in patients with opioid dependence treated with buprenorphine and methadone in comparison with healthy persons

Memory function in patients with opioid dependence treated with buprenorphine and methadone in comparison with healthy persons 
Scientific Reports
This study compared memory performance in patients treated with methadone or buprenorphine for drug abuse to healthy controls using the Wechsler Memory Scale. Healthy controls performed better than both treatment groups in mental control. Methadone patients scored higher than controls in personal and general information, while buprenorphine patients scored lower in associate learning. Longer buprenorphine treatment was linked to better overall memory scores, and patients on methadone for over two years showed better awareness of place and time compared to long-term buprenorphine users. Overall, neither medication showed major negative effects on memory except for mental control, which was impaired in both groups. Buprenorphine appeared to better preserve memory function over time than methadone.
 
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Lead: Medicaid Unwinding and Changes in Buprenorphine Dispensing

Medicaid Unwinding and Changes in Buprenorphine Dispensing 
JAMA Network Open
Among Medicaid-insured adults with buprenorphine use, this cross-sectional study examined if changes in buprenorphine dispensing were greater among those residing in states with the highest vs lowest decreases in Medicaid enrollment after “Medicaid unwinding” began in April 2023. Researchers used 2017-2023 data from a national prescription dispensing database that included 754,675 person-years from 569,069 patients. They found that patients in states with the highest decreases in Medicaid enrollment were more likely to decrease buprenorphine use, discontinue buprenorphine therapy, and use private insurance or cash to pay for buprenorphine prescriptions. The finding that Medicaid unwinding was associated with disruptions in buprenorphine therapy raises concerns about the potential for increased opioid-related morbidity and mortality.
 
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Lead: Loneliness Among US Veterans With Problematic Substance Use: Results From the National Health and Resilience in Veterans Study

Loneliness Among US Veterans With Problematic Substance Use: Results From the National Health and Resilience in Veterans Study
Journal of Addiction Medicine
Loneliness is a major public health concern, especially among individuals with problematic substance use (PSU), but little research has focused on vulnerable groups like US military veterans. This study, using data from the National Health and Resilience in Veterans Study, found that nearly half of veterans with PSU (47.4%) experience clinically significant loneliness. Factors contributing to loneliness included being unmarried, higher psychological distress (depression and PTSD), a history of suicide attempts, physical disability, smaller social networks, and lower purpose in life and optimism. The analysis highlighted that depressive and PTSD symptoms had the strongest impact on loneliness, followed by social network size and sense of purpose. Furthermore, veterans with depressive symptoms who had a strong sense of purpose were less likely to feel lonely. The study underscores the need for strategies targeting psychological distress, fostering social connections, and enhancing purpose to help alleviate loneliness in this population.
 
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Lead: The IARC Perspective on the Effects of Policies on Reducing Alcohol Consumption

The IARC Perspective on the Effects of Policies on Reducing Alcohol Consumption
New England Journal of Medicine
In 2020, alcohol use was responsible for over 740,000 new cancer cases worldwide. In response, The International Agency for Research on Cancer (IARC) released a two-part handbook assessing the effectiveness of public policy measures in reducing alcohol-related cancer risk. The report found that reducing or stopping alcohol consumption lowers the risk of certain cancers and that several policy interventions, such as increasing alcohol taxes; setting minimum pricing; restricting sales by time, place, and age; implementing total sales bans; and enacting strong marketing restrictions, effectively reduce alcohol consumption. Government-run alcohol monopolies and coordinated national strategies were also associated with decreased use. However, bans on alcohol discounts produced inconsistent results. These findings align with the WHO’s Global Alcohol Action Plan and SAFER initiative, highlighting the importance of targeted, enforceable strategies to reduce alcohol-related harm globally. 
 
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Lead: Building Multidisciplinary Consensus on Inpatient Xylazine Management through Clinical Protocols

Building Multidisciplinary Consensus on Inpatient Xylazine Management through Clinical Protocols
Substance Use and Addiction Journal
Xylazine in the unregulated drug supply produces significant morbidity and this paper describes utilizing a multidisciplinary team to develop protocols for inpatient setting to manage patients with xylazine exposure. Protocols developed included use of scheduled clonidine or tizanidine to manage withdrawal with hold parameters. As there is no FDA approved immunoassay screen, they recommended assuming xylazine exposure in areas with high prevalence and limited testing. The team also developed guidelines for cases in which surgical interventions would be considered, when to culture wounds, antibiotic usage, and consistent wound care based on size and clinical characteristics. In addition, they developed standardized discharge instructions, including referral to substance use disorder treatment, harm reduction and education around xylazine test strip use.  
 
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Lead: Varenicline for Youth Nicotine Vaping Cessation: A Randomized Clinical Trial

Varenicline for Youth Nicotine Vaping Cessation: A Randomized Clinical Trial
Journal of the American Medical Association
This 12-week randomized clinical trial in 261 treatment-seeking youth aged 16 to 25 years assessed if varenicline, when added to brief, remotely delivered behavioral support, was efficacious and well tolerated for nicotine vaping cessation in youth.  Researchers found that continuous abstinence rates were higher in the varenicline group than in the placebo group in the last month of treatment (51% vs 14%) and at 6-month follow-up (28% vs 7%). Treatment-emergent adverse events did not differ significantly between groups. Varenicline, when added to brief cessation counseling, is well tolerated and promotes nicotine vaping cessation compared with placebo in youth with addiction to vaped nicotine.
 
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Lead: Comprehensive drug policies increase trust in local government: an analysis of authorities’ and residents’ perspectives in rural US Appalachian and Midwestern counties

Comprehensive drug policies increase trust in local government: an analysis of authorities’ and residents’ perspectives in rural US Appalachian and Midwestern counties 🔓
Harm Reduction Journal
Implementation of harm reduction intervention policies by local governments may be met with caution because of concern about potential backlash from communities and erosion of public trust. The authors conducted two studies to assess the influence of perceptions of government support for comprehensive drug policies (including harm reduction) on public trust in local government. In both a field study and an experimental study, the authors found that public trust was positively associated with increased perception of government support for comprehensive drug policies. The authors note residents recognized harm reduction policies as a step to address the issue of drug use, and these findings may ease some concerns about public pushback for local government officials when considering these policies. 
 
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Lead: Hospital Addiction Consultation Service and Opioid Use Disorder Treatment

Hospital Addiction Consultation Service and Opioid Use Disorder Treatment
JAMA Internal Medicine
While medication for opioid use disorder (MOUD) is effective, many patients with OUD do not receive it, particularly in hospitalized settings. In this randomized trial they evaluated the Substance Use Treatment and Recovery Team (START) model, a team of an addiction medicine provider and a care manager, and provided motivational interviewing, discharge planning and telephone follow-up for one month. Patients who received the START intervention were more likely to receive MOUD (aRR=2.10) and connect to OUD care after discharge (aRR=1.49). In addition, these patients were more likely to have an OUD-focused discharge plan (aRR=1.8), initiate or continue MOUD post discharge (aRR=1.71), and see a clinician for OUD post discharge (aRR=1.89). These findings support use of hospital-based addiction consult services to address this healthcare gap.
 
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Lead: Averted lung cancer deaths due to reductions in cigarette smoking in the United States, 1970–2022

Averted lung cancer deaths due to reductions in cigarette smoking in the United States, 1970–2022 
Cancer
Smoking prevalence peaked in the 50s and 60s but has declined following the US Surgeon General’s report in 1964 on its health risk. As 85% of lung cancer is attributable to smoking, the authors evaluated this impact by assessing lung cancer deaths averted, and person-years of life (PYL) gained between 1970 and 2022 using cancer mortality data from the CDC. The authors estimated 3,856,240 lung cancer deaths were averted and 76,275,550 PYL were gained during the study period (average of 19.8 PYL gained per death averted). The deaths averted were higher in men (2,246,610), but average PYL gained per death averted was higher in women (22.4 years). Lung cancer deaths averted accounted for 51.4% of the estimated decrease in overall cancer deaths.  The findings highlight the importance of tobacco controls and interventions and need for ongoing efforts to decrease tobacco use. 
 
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Lead: Prescription Stimulant Use, Misuse, and Use Disorder Among US Adults Aged 18 to 64 Years

Prescription Stimulant Use, Misuse, and Use Disorder Among US Adults Aged 18 to 64 Years 
JAMA Psychiatry
This study examined the prevalence of prescription stimulant use, prescription stimulant misuse, and prescription stimulant use disorder (PSUD) among adults aged 18 to 64 years in the US. Researchers found that 25.3% of adults in the study reported misuse, and 9.0% had PSUD. Among those with PSUD, 72.9% solely used their own prescribed stimulants, 87.1% used amphetamines, 42.5% reported no misuse, and 63.6% had mild PSUD. The prevalence of misuse was 3.1 times higher and the prevalence of PSUD was 2.2 times higher among those using prescription amphetamines than among those using methylphenidate. Regardless of prescription stimulant misuse status, screening for and treating PSUD is needed for US adults aged 18 to 64 years using prescription stimulants, especially those receiving prescription amphetamines. 
 
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