This Week in Addiction Medicine from ASAM

Lead: Naloxone Use in Novel Potent Opioid and Fentanyl Overdoses in Emergency Department Patients

Lead Story:
Naloxone Use in Novel Potent Opioid and Fentanyl Overdoses in Emergency Department Patients 
JAMA Network Open
In this cohort study of 537 patients, all patients with novel potent opioid (NPO) overdose presented with opioid overdose symptoms and received multiple doses of naloxone. Compared with fentanyl overdose, patients with NPO overdose had a higher number of naloxone doses administered in-hospital; metonitazene overdose was associated with cardiac arrest and more naloxone doses overall. These findings suggest that NPOs may have a higher potency than fentanyl due to the observed naloxone administration in the clinical setting of overdose.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Examining sociodemographic correlates of opioid use, misuse, and use disorders in the All of Us Research Program

 
Lead Story:
Examining sociodemographic correlates of opioid use, misuse, and use disorders in the All of Us Research Program 🔓
PLOS ONE
This study aims to estimate the prevalence of opioid use and its association with sociodemographic characteristics from survey data and electronic health record (EHR). A total of 214,206 participants completed survey modules and shared EHR data. The lifetime prevalence of street opioids was 4%, and the nonmedical use of prescription opioids was 9%. Men had higher odds of lifetime opioid use but reduced odds of current nonmedical use of prescription opioids. Participants from other racial and ethnic groups were at reduced odds of lifetime use but increased odds of current use compared with non-Hispanic White participants. Foreign-born participants were at reduced risks of opioid use and diagnosis of opioid use disorders (OUD) compared with US-born participants. Men, younger, white, and US-born participants were more likely to have OUD.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US

Lead Story:
Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal
JAMA Network Open
This cross-sectional study investigated the prevalence of cannabis use disorder (CUD) among primary care patients in states with legal recreational cannabis. Patients were asked to report medical use, nonmedical use, or both, with 42.4% reporting medical use only, 25.1% nonmedical use only, and 32.5% reporting both. The prevalence of any CUD was 21.3%; for moderate to severe CUD prevalence was 6.5% overall, with 1.3% reporting medical use, 7.2% nonmedical use, and 7.5% reporting both. Those reporting medical use only tended to be older, female, and retired. Those reporting nonmedical use or both were more likely to disclose withdrawal; use in hazardous situations; use despite persistent or recurrent social or interpersonal problems; important social, occupational, or recreational activities given up or reduced; and use despite persistent or recurrent social or interpersonal problems. Hence, screening for CUD among patients who use cannabis is paramount.

Special Episode: ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder

Special Guest:
Melissa Weimer, DO, MCR, FASAM
Article Referenced:
ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids 
ASAM Resources:
ASAM Clinical Guidelines
2020 National Practice Guideline for the Treatment of Opioid Use Disorder
ASAM's Treatment of Opioid Use Disorder Virtual Course
ASAM's Moving Beyond the Barriers of Treating Opioid Use Disorder Live CourseOUD Treatment Education
Sign Up for the Q&S Newsletter
Sign Up for the ASAM Weekly
ASAM Membership 
 

Lead: Marijuana and hallucinogen use, binge drinking reached historic highs among adults 35 to 50

Lead Story:
Marijuana and hallucinogen use, binge drinking reached historic highs among adults 35 to 50 
NIDA News
According to data from the Monitoring the Future (MTF) study, use of marijuana and hallucinogens reached their highest levels ever for people 35-50 years of age in 2022. Binge drinking among this age group also reached peak levels. For those 19-30 years of age, marijuana and vaping reached their highest levels since reporting MTF data. Past year use of other substances including sedatives, cigarettes, and non-prescribed opioids, however, revealed a 10-year decline for both age groups. According to NIDA director Dr. Nora Volkow, “Understanding these trends is a first step, and it is crucial that research continues to illuminate how substance use and related health impacts may change over time.”
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Perceptions of Safety of Daily Cannabis vs Tobacco Smoking and Secondhand Smoke Exposure

Perceptions of Safety of Daily Cannabis vs Tobacco Smoking and Secondhand Smoke Exposure, 2017-2021 
JAMA Network Open
This study investigated perceived safety of cannabis vs. tobacco from 2017-2021 via daily smoking or secondhand exposure. The study found a significant shift in beliefs about the safety of daily smoking of cannabis vs. tobacco, with more than one-third reporting cannabis was safer than tobacco, and these numbers increased over time. Results were similar regarding secondhand cannabis smoke, with over 40% reporting it safer than secondhand tobacco smoke. Younger people and those who were unmarried were more likely to view cannabis as safer. A public health and regulatory response is therefore imperative to inform people of the known health risks associated with both daily cannabis smoking as well as secondhand exposure.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Alcohol Intake and Blood Pressure Levels

Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies 🔓
Hypertension
Employing a systematic search of longitudinal studies, the authors investigated links between blood pressure and alcohol intake. A considerable linear positive association was found between baseline alcohol intake and changes over time in both systolic blood pressure (SBP) and diastolic blood pressure (DBP). Average SBP was 1.25 and 4.90 mm Hg higher for 12 or 48 grams of alcohol compared with no drinking. The differences were for DBP were 1.14 and 3.10 mm Hg. There was no evidence of a threshold for this connection. 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Special Episode: The Future of Psychedelic Therapy and Addiction Treatment

Special Guest:
David E. Smith, MD, DFASAM
Editorial Referenced: 
The Future of Psychedelic Therapy and Addiction Treatment 
ASAM Resources: 
ASAM Clinical Guidelines
On-Demand Session: Psychedelics for Substance Use Disorders: Preparing for the Impending Paradigm Shift
Sign Up for the Q&S Newsletter
Sign Up for the ASAM Weekly
ASAM Membership 

Lead: ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder

Lead Story
ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids 🔓
Journal of Addiction Medicine
This clinical considerations document is based on a narrative literature review and expert consensus and addresses considerations for changes to the clinical practice of treatment of opioid use disorder (OUD) with buprenorphine for individuals using high-potency synthetic opioids (HPSOs). Broadly, it suggests that individualized strategies for buprenorphine initiation may be needed. The experience of opioid withdrawal negatively impacts the success of buprenorphine treatment, and attention to withdrawal management before and during buprenorphine initiation should be proactively addressed. Buprenorphine dose and dosing frequency should be individualized based on patients’ treatment needs, the possibility of novel components in the drug supply should be considered during OUD treatment, and all forms of opioid agonist treatment should be offered and considered for patients.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Recommendations for Reducing the Risk of Cannabis Use-Related Adverse Psychosis Outcomes

Lead Story: 
Recommendations for Reducing the Risk of Cannabis Use-Related Adverse Psychosis Outcomes: A Public Mental Health-Oriented Evidence Review 🔓
Journal of Dual Diagnosis
As legal controls liberalize around cannabis, the authors reviewed the literature about links between cannabis use and psychosis to make recommendations for consumers, health professionals, and policy makers to decrease risk of developing psychosis symptoms. The authors provide 11 recommendations and the level of evidence for each. Recommendations based on the most substantial evidence of linkage to psychosis include: 1) avoid use in adolescence (<16), 2) avoid cannabis with high tetrahydrocannabinol (THC) concentration, 3) limit frequency of use, 4) avoid use if experiencing psychosis symptoms or receiving treatment, and 5) avoid use if one has other risk factors for developing psychosis.
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM