This Week in Addiction Medicine from ASAM

Lead: Relationship between alcohol use and firearm-involved suicide

Lead Story: 
Relationship between alcohol use and firearm-involved suicide: Findings from the National Violent Death Reporting System, 2003-2020
American Journal of Preventive Medicine
This study evaluated the sex- and age group-specific relationship between alcohol intoxication and firearm-involved suicide. Among males of all ages and young and middle-aged females, alcohol intoxication was associated with increased risk of suicide by firearm, an extremely lethal method that accounts for a majority of suicides in the US, compared to their non-intoxicated counterparts. Interventions targeting excessive alcohol consumption may be effective in reducing suicide mortality rates
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Lead: Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic

Lead Story:
 
Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic
JAMA Psychiatry
This cross-sectional exploratory study examined knowledge gaps in overdose deaths among pregnant and postpartum persons from 2018-2021 as compared to nonpregnant overdose deaths and obstetrical deaths. Overdose deaths among pregnant and postpartum women consistently increased among those aged 10 to 44 years, and more than tripled among those aged 35 to 44 years, from 4.9 per 100,000 from January-June 2018 to 15.8 from July-December 2021. These deaths differed from nonpregnant overdose deaths and obstetrical deaths in sociodemographic characteristics and place of death. Among overdose deaths in total (pregnant and nonpregnant), nearly 75% occurred outside of health care settings. Clearly more work needs to be done to treat SUDs in this population. 
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Lead: 2022 National Survey on Drug Use and Health

Lead Story:
2022 National Survey on Drug Use and Health (NSDUH) 
SAMHSA 
Key findings include that in 2022, 70.3 million people aged 12 or older (or 24.9%) used illicit drugs in the past year. Marijuana was the most used illicit drug, with 22.0% of people aged 12 or older (or 61.9 million people) using it in the past year. In 2022, 48.7 million people aged 12 or older (or 17.3%) had a substance use disorder (SUD) in the past year, including 29.5 million who had an alcohol use disorder (AUD), 27.2 million who had a drug use disorder (DUD), and 8.0 million people who had both an AUD and a DUD. Almost 1 in 4 adults aged 18 or older had any mental illness (AMI) in the past year (59.3 million or 23.1%) and among adolescents aged 12 to 17 in 2022, 19.5% (or 4.8 million people) had a past year major depressive episode (MDE).
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Lead: Fast dopamine increases drug reward

Lead Story:
Neural circuit selective for fast but not slow dopamine increases in drug reward🔓
Nature Communications
The authors note that rapid delivery to the brain when drugs are injected or smoked results in more severe substance use disorders. They used functional MRI and PET scans to monitor dopamine increases while subjects (n=20) received methylphenidate either orally or intravenously. Intravenous methylphenidate caused a more rapid increase in dopamine than oral. Activity in the medial prefrontal cortex decreased in both groups but was more pronounced with intravenous methylphenidate. However, only intravenous methylphenidate produced increased activity in the dorsal anterior cingulate cortex and insula that was reflected in the subjective rating of “high.”  This brain region was activated only by intravenous methylphenidate and the associated rapid increase in dopamine.
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Lead: Public health approaches to gambling

Lead Story:
Public health approaches to gambling: a global review of legislative trends 
The Lancet Public Health
Authors of this article systematically reviewed legislation of jurisdictions that introduced major gambling legislation change (i.e., restricting or extending gambling provision) between Jan 1, 2018, and Dec 31, 2021. More than 80% of countries worldwide now legally permit gambling. Harmful gambling was recognized as a health and wellbeing issue in most of the analyzed jurisdictions, but near-exclusive focus was given to individual-level harms rather than to wider social and economic harms or harms to others. Most of the proposed prevention measures focused on individual responsibility. Gambling policies worldwide are changing, but addressing gambling as a public health issue has not yet translated into comprehensive policy action across jurisdictions.
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Lead: Clinical Practice Guideline on the Management of Stimulant Use Disorder

Lead Story:
Clinical Practice Guideline on the Management of Stimulant Use Disorder 
American Society of Addiction Medicine and American Academy of Addiction Psychiatry
Overdose deaths involving stimulant drugs – including cocaine, methamphetamine, amphetamine, and prescription stimulants – have been rising precipitously over the past decade. In 2021, over fifty percent of overdose deaths in the US involved stimulant drugs. Beyond the mortality risk, stimulant use disorders (StUD) can also lead to long term health problems including infectious diseases, cardiac, pulmonary, psychiatric, dental, nutritional, skin, and cognitive issues.  The Clinical Practice Guideline on the Management of Stimulant Use Disorder, developed by the American Society of Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP), provides information on evidence-based strategies and standards of care for the prevention and treatment of stimulant use disorders (StUD), stimulant intoxication, and stimulant withdrawal.
 
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Lead: Chronic pain, cannabis legalisation, and cannabis use disorder

Lead Story:
Chronic pain, cannabis legalisation, and cannabis use disorder among patients in the US Veterans Health Administration system, 2005 to 2019: a repeated, cross-sectional study
The Lancet Psychiatry
The prevalence of cannabis use disorder (CUD) in patients with chronic pain is increasing. This study considered the impact of both recreational (RCL) and medical cannabis laws (MCL) on the diagnosis of CUD using a VA population with chronic pain. Results demonstrate that MCL led to a 0.135% increase in the prevalence of CUD. Enacting RCL led to a 0.188% increase in its prevalence. The authors emphasize the importance of these findings and their public health implications, with a focus on clinician monitoring and patient education.
 
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Lead: Xylazine Adulteration of the Heroin–Fentanyl Drug Supply

Lead Story:
 
Xylazine Adulteration of the Heroin–Fentanyl Drug Supply
Annals of Internal Medicine
Since 2016, xylazine has appeared in the illicitly manufactured fentanyl supply and has increased in prevalence, due to its low cost, easy availability, and presumed synergistic psychoactive effect. It remains unclear whether a distinct xylazine withdrawal syndrome occurs. Xylazine may alter the findings and management of patients with fentanyl overdose and withdrawal. Inadequately treated opioid (and possibly xylazine) withdrawal contributes to the increase in self-directed discharges from treatment settings. Initiation of buprenorphine and perhaps methadone may be compounded by the concomitant use of xylazine. The presence of extensive wounds in people who use xylazine prevents them from accessing resources, including medically managed withdrawal treatment, leading to a cycle of continued and escalating use.
 
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Lead: Heterogeneous neuroimaging findings across substance use disorders localize to a common brain network

Lead Story:
 
Heterogeneous neuroimaging findings across substance use disorders localize to a common brain network 
Nature Mental Health
This study used network mapping approaches and a functional connectome from a large cohort of healthy participants (n = 1,000) to test whether neuroimaging abnormalities across substance use disorders map to a common brain network. Starting with coordinates of regional brain atrophy from 45 studies, researchers found that 91% of the neuroimaging findings mapped to a common brain network specific to substance use disorders compared to atrophy associated with normal aging and neurodegenerative disease. Coordinates of functional MRI abnormalities from 99 studies mapped to a similar brain network. Neuroimaging abnormalities across substance use disorders map to a common brain network that is similar across imaging modalities, substances, and lesion locations that cause remission from substance use disorders.
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Lead: The association between temperature and alcohol- and substance-related disorder hospital visits

Lead Story:
The association between temperature and alcohol- and substance-related disorder hospital visits in New York State 
Communications Medicine
Using New York State hospital data, this study investigated the link between daily temperature and hospital visits as a result of substance use from 1995-2014. An increase in temperature 0-6 days prior to seeking hospital care was associated with an increase in rates in care. Increase in visits was highest when opioids were involved, and lowest for sedatives. The 25-44 age group was primarily affected, and males made up the highest proportion of cases. These results indicate that the rise in SUD hospital visits is linked to continued rising temperatures related to climate change; healthcare and social interventions could potentially mitigate these harms.
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