This Week in Addiction Medicine from ASAM

Lead: Subtypes in addiction and their neurobehavioral profiles across three functional domains

Lead Story
Subtypes in addiction and their neurobehavioral profiles across three functional domains 
Translational Psychiatry
Over two-thirds of the 40.3 million people in the U.S. who have a substance use disorder (SUD) return to use within weeks to months of initiating treatment, and up to 85% of individuals return to substance use within one year of treatment completion. This study hypothesized that considerable individual differences exist in the three functional domains underlying addiction — approach-related behavior, executive function, and negative emotionality. Results support functionally derived subtypes, demonstrating considerable individual heterogeneity in the multi-dimensional impairments in addiction. This confirms the need for mechanism-based subtyping to inform the development of personalized addiction medicine approaches.
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Lead: The conserved endocannabinoid anandamide modulates olfactory sensitivity to induce hedonic feeding in C. elegans

Lead Story:
The conserved endocannabinoid anandamide modulates olfactory sensitivity to induce hedonic feeding in C. elegans 
Current Biology
Laboratory worm Caenorhabditis elegans apparently gets the ‘munchies’ when exposed to cannabis. After soaking in an endocannabinoid bath, worms preferred to eat nutrient-rich, rather than nutrient-poor, bacteria. They fed for longer than worms not exposed to endocannabinoid or worms without working endocannabinoid receptors. This shared trait points to the deep evolutionary origin of cannabinoid receptors and behaviors influenced by the molecules.
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Lead: Opioid Prescribing and Suicide Risk in the United States

Lead Story:
Opioid Prescribing and Suicide Risk in the United States
The American Journal of Psychiatry
Approximately 40% of overdose suicide deaths in the United States involve opioids. Because of their respiratory depression effects and narrow therapeutic window, opioids pose a greater risk than any other drug class of an intentional overdose proving to be lethal.  In this retrospective study of US commuting zone–level opioid prescriptions and mortality, regional decreases in opioid prescriptions were consistently associated with declines in total suicide deaths, including suicide overdose deaths involving opioids. For some opioid prescribing measures, negative associations were observed with unintentional overdose deaths involving opioids among younger people. Individual-level inferences are limited by the ecological nature of the analysis.
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Lead: Association Between Daily Alcohol Intake and Risk of All-Cause Mortality

Lead Story
Association Between Daily Alcohol Intake and Risk of All-Cause Mortality 
JAMA Network Open
This updated systematic review and meta-analysis investigated the association between alcohol use and all-cause mortality. Among occasional (>0 to

Lead: Genetic Liability for Alcohol Consumption, Alcohol Problems and Suicide Attempts

Lead Story: 
Shared genetic liability for alcohol consumption, alcohol problems, and suicide attempt: Evaluating the role of impulsivity 
Translational Psychiatry
This study investigated the extent to which shared liability for alcohol consumption and problems (ACP) and suicide attempt (SA) is genetically related to five dimensions of impulsivity. Common genetic liability to ACP and SA was significantly correlated with all five impulsive personality traits examined, and the largest correlation was with lack of premeditation, though supplementary analyses suggested that these findings were potentially more strongly influenced by ACP than SA. These analyses have potential implications for screening and prevention: Impulsivity can be comprehensively assessed in childhood, whereas heavy drinking and suicide attempt are quite rare prior to adolescence. Features of impulsivity may serve as early indicators of genetic risk for alcohol problems and suicidality.
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Lead: Genome-wide association study identifies loci underlying multiple substance use disorders

Lead Story: 
Multivariate genome-wide association meta-analysis of over 1 million subjects identifies loci underlying multiple substance use disorders 
Nature Mental Health
Recent large-scale genome-wide association studies (GWASs) show that the genetic architecture of substance use disorders (SUDs) is characterized by a high degree of commonality, i.e., a general addiction genetic factor likely conveys vulnerability to multiple SUDs. Genetic liability to substance use disorders can be parsed into loci that confer general or substance-specific addiction risk. This is a multivariate genome-wide association meta-analysis that disaggregates general and substance-specific loci from published summary statistics of SUDs. Findings provide insight into genetic risk loci for substance use disorders that could be leveraged as treatment targets.
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Special Episode: Emergency Room Treatment of AUD

Special Guest:
Lewis S. Nelson, MD, MBA, DFASAM
 
Article Referenced:  
R.J. Strayer et al., EMERGENCY DEPARTMENT MANAGEMENT OF PATIENTS WITH ALCOHOL INTOXICATION, ALCOHOL WITHDRAWAL, AND ALCOHOL USE DISORDER: A WHITE PAPER PREPARED FOR THE AMERICAN ACADEMY OF EMERGENCY MEDICINE, Journal of Emergency Medicine, https://doi.org/10.1016/j.jemermed.2023.01.010  
 
ASAM Resources: 
The ASAM Clinical Practical Guideline on Alcohol Withdrawal Management
Alcohol Withdrawal Management Pocket Guide
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Lead: Human brain effects of DMT assessed via EEG-fMRI

Lead Story:
Human brain effects of DMT assessed via EEG-fMRI 
PNAS
Interest in psychedelics as potential treatment for depression has increased. In this study, researchers examine the effects of N,N-Dimethyltryptamine (DMT) on brain function using electroencephalography (EEG) and functional MRI (fMRI). The study found a dysregulating effect on activity in the transmodal association pole (TOP) an area with high expression of serotonin 2A receptors (5-HT2AR). The authors also found increased communication between TOP and the rest of the brain, which may be evidence of increased information processing and hyperassociative cognition. They were able to correlate their findings through simultaneous EEG, fMRI, and symptom reports from participants. 
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Lead: Characteristics of Fatal Poisonings Among Infants and Young Children in the United States

Characteristics of Fatal Poisonings Among Infants and Young Children in the United States 
Pediatrics
Child death reviews present an opportunity to improve understanding of fatal poisonings. This study employed the National Fatality Review-Case Reporting System (NFR-CRS), a national standardized reporting tool, to describe the demographics of childhood deaths by poisoning, identify associated factors, and characterize those deaths attributable to opioids. Opioids were the most common substance (47.3%) contributing to death in young children, followed by OTC pain, cold, and allergy medications (14.8%). There was a substantial rise in these opioid-involved deaths over time, from 24.1% of the substances contributing to deaths in 2005 compared with 52.2% in 2018, illustrating the impact of the opioid epidemic on young children. Opportunities for naloxone education are paramount.
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Lead: Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy

Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy 
The Lancet Public Health
In this review article, methadone take-home dosing considerations during the COVID-19 pandemic were examined. A search of published research on the flexibility of these practices, patient-provider experience, health outcomes, and how these findings might influence updated regulations was performed. The review found no evidence of increased methadone overdose risk as a result of greater pandemic flexibility. Benefits of such policy include potentially improved treatment retention and impressive improvements in patient quality of life. This is key for SAMHSA as it ponders the steps to make these flexibilities permanent.
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