This Week in Addiction Medicine from ASAM

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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Lead: US tobacco companies selectively disseminated hyper-palatable foods into the US food system

Lead Story:
 
US tobacco companies selectively disseminated hyper-palatable foods into the US food system: Empirical evidence and current implications
Addiction
Hyper-palatable foods (HPF) contain fat and sodium, fat and simple sugars, and carbohydrate and sodium at specific thresholds to induce hyperpalatability, creating an artificially rewarding experience. This study compared tobacco companies who owned food companies to food companies not owned by tobacco companies, with regard to hyperpalatability between 1988 and 2001. Upon review of industry documents, this study found that tobacco companies “selectively disseminated” HPF into the US market. Tobacco-owned foods were 29% more likely to be classified as fat and sodium HPF and 80% more likely to be classified as carbohydrate and sodium HPF than foods that were not tobacco-owned. As late as 2018, market saturation of fat and sodium HPF was close to 60% and carbohydrate and sodium HPF was almost 20% regardless of tobacco ownership. Further research should consider the links between industries to appreciate potential impact on public health.
 
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Lead: America’s Opioid Ecosystem: How Leveraging System Interactions Can Help Curb Addiction, Overdose, and Other Harms

Lead Story:
America's Opioid Ecosystem: How Leveraging System Interactions Can Help Curb Addiction, Overdose, and Other Harms 
RAND Corporation
This ebook highlights that although opioids play an outsized role in US drug problems, they also play a critically important role in medicine. Thus, they deserve special attention. Illegally manufactured opioids are involved in a majority of US drug overdoses. Efforts to address problems related to opioids are insufficient and sometimes contradictory.  Components of the opioid ecosystem include substance use disorder treatment, harm reduction, medical care, the criminal legal system, illegal supply and supply control, first responders, the child welfare system, income support and homeless services, employment, and education. Leveraging the interactions of the opioid ecosystem can reduce addiction, overdose, suffering, and other harms.
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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.
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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.
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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
Treatment of opioid use disorder (OUD) with buprenorphine has evolved considerably in the last decade as the scale of the OUD epidemic has increased along with the emergence of high-potency synthetic opioids (HPSOs) and stimulants in the drug supply. These changes have outpaced the development of prospective research, so a clinical consideration document based on expert consensus is needed to address pressing clinical questions. 
Article Referenced:
The Journal of Addiction Medicine abstract article can be found here>>>
 
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
 
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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.”
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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.
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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. 
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