This Week in Addiction Medicine from ASAM

Lead: Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits

Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits 
Journal of General Internal Medicine
The American Society of Addiction Medicine (ASAM), in collaboration with nine other medical societies and professional associations, developed evidence-based guidelines for tapering benzodiazepine (BZD) medications across various clinical settings. These guidelines were created using a modified GRADE methodology and a clinical consensus process, which included a systematic literature review and several targeted supplemental searches. The guidelines were also revised based on feedback from external stakeholders. Key recommendations include that clinicians should continually assess the risks and benefits of BZD use and tapering. They should engage in shared decision-making with patients and avoid abrupt discontinuation in individuals who may be physically dependent or at risk of withdrawal. Tapering strategies should be personalized and adjusted based on the patient’s response. Additionally, clinicians are encouraged to provide psychosocial support to help patients successfully taper off BZDs.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Receipt of addiction treatment after nonfatal opioid overdose and risk of subsequent overdose: A retrospective cohort study

Receipt of addiction treatment after nonfatal opioid overdose and risk of subsequent overdose: A retrospective cohort study
Drug and Alcohol Dependence
People who experience a nonfatal opioid overdose are at increased risk of subsequent overdose but is also a potential moment to intervene. In this cohort study, they used statewide data from Connecticut to assess differences in overdose outcomes in the year following a nonfatal overdose by treatment type received. Overall, 56% of patients received no treatment, while 35% received medication for opioid use disorder (MOUD) (25% buprenorphine and 11% methadone) and 21% received inpatient treatment (detox and/or extended inpatient). Both methadone (aHR=0.41) and buprenorphine (aHR=072) were associated with decrease in subsequent overdose, whereas neither detox nor prolonged inpatient treatment were associated with decreased overdose. These findings further support the importance of MOUD and the need to increase access to treatment in this high-risk population.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Bitter sensing protects Drosophila from developing experience-dependent cocaine consumption preference

Bitter sensing protects Drosophila from developing experience-dependent cocaine consumption preference
The Journal of Neuroscience
Cocaine use disorder (CUD) is a highly heritable condition for which there are no effective treatments. Testing the many human genetic variants linked to CUD requires a cost-effective, genetically tractable model. This study showed that bitter-sensing neurons prevent cocaine self-administration in Drosophila. Disrupting Drosophila bitter perception enables a model for experience-dependent cocaine preference. The findings underscore the potential of Drosophila as a crucial tool for identifying the genetic mechanisms underlying CUD, aiding in the discovery of new therapeutic targets, and contributing to the development of effective treatments for this highly heritable disease.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit 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.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

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.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

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.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

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. 
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

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.  
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

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.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

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. 
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM