This Week in Addiction Medicine from ASAM

Lead Story: Defining Recovery From Alcohol Use Disorder: Development of an NIAAA Research Definition

Defining Recovery From Alcohol Use Disorder: Development of an NIAAA Research Definition
The American Journal of Psychiatry
The authors present a newly developed National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of recovery from the DSM-5 diagnosis of alcohol use disorder (AUD). This definition views recovery as a process of behavioral change and an outcome, incorporating two key components of recovery: remission from DSM-5 AUD and cessation from heavy drinking, a non-abstinent recovery outcome. It also emphasizes the importance of biopsychosocial functioning and quality of life in enhancing outcomes. By adopting a uniform definition, researchers and health care professionals can more precisely operationalize and measure recovery-related processes.
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Lead Story: Genetic diversity fuels gene discovery for tobacco and alcohol use

Genetic diversity fuels gene discovery for tobacco and alcohol use 
Nature
This study leverages global genetic diversity across 3.4 million individuals from four major clines of global ancestry to power the discovery and fine-mapping of genomic loci associated with tobacco and alcohol use, to inform function of these loci via ancestry-aware transcriptome-wide association studies, and to evaluate the genetic architecture and predictive power of polygenic risk within and across populations. The authors found that increases in sample size and genetic diversity improved locus identification and fine-mapping resolution, and that a large majority of the associated variants showed consistent effect sizes across ancestry dimensions. However, polygenic risk scores developed in one ancestry performed poorly in others, highlighting the continued need to increase sample sizes of diverse ancestries to realize any potential benefit of polygenic prediction.
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Lead Story: Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy

Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy 
The New England Journal of Medicine
This cohort study involving pregnant persons in the US from 2000-2018 found that buprenorphine treatment for opioid use disorder during pregnancy was associated with more favorable neonatal outcomes than methadone treatment. Neonatal abstinence syndrome occurred in 69% of the infants exposed to methadone as compared with 52% of those exposed to buprenorphine in the 30 days before delivery. An inverse association was also observed between buprenorphine exposure (as compared with methadone exposure) and preterm birth, regardless of whether exposure occurred in early or late pregnancy in both the unadjusted and adjusted analyses. Inverse associations were also observed between buprenorphine exposure (as compared with methadone exposure) and small size for gestational age and low birth weight.
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Lead Story: Increased vulnerability to atrial and ventricular arrhythmias caused by different types of inhaled tobacco or marijuana products

Increased vulnerability to atrial and ventricular arrhythmias caused by different types of inhaled tobacco or marijuana products 
Heart Rhythm
This study investigated the cardiovascular effects of exposure to tobacco smoke, vape aerosol, heated tobacco products, marijuana smoke, THC free marijuana, or air (placebo control). Rats were exposed to a single 5 minute session 5 days a week for 2 months. This exposure was judged to be similar to a single smoking or vaping session a day. Left ventricular dilation and reduction in LV ejection fraction was seen in all non-air groups along with reduction in heart rate variability. Both atrial fibrillation and ventricular tachycardia were more easily induced in all non-air groups. Decrease in microvessel density and severe interstitial fibrosis was seen on histology from all non-air groups. The authors conclude that all tobacco products (including vaping) and marijuana carry substantial risk of cardiac disease.
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Lead Story: Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study

Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study 
BMC Public Health
The authors note a dramatic increase in the use of methamphetamine in people with OUD and an increased presence of a stimulant in opioid toxicity deaths. A random sample of 20% of persons in the overdose registry of the Province of British Columbia, Canada, was selected for years 2010 to 2018. Persons who used opioids, stimulants, or both (n=7460) were identified by ICD codes and fatal overdose events determined from coroners’ data. People using both opioids and stimulants had twice the risk of fatal overdose compared to those using opioids only (HR=2.02, p

Lead Story: Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression

Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression
NEJM
Results of a phase II trial testing the psychedelic compound in magic mushrooms as a treatment for depression have found that the drug psilocybin is effective, but not to the extent that earlier, smaller studies had suggested. The proportion of participants in remission after treatment dropped over time, raising questions about its durability and whether additional doses would be helpful. Among adults with treatment-resistant depression, a single dose of 25 mg of psilocybin, but not 10 mg, reduced depression severity significantly more than a 1-mg dose at 3 weeks. The trial did not compare psilocybin with existing treatments for depression and persons who were judged to be at a clinically significant risk for suicide were excluded from the trial.
 
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Lead Story: Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019

Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019 
JAMA Network Open 
This cross-sectional study sought to estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults 20 to 64 years of age. Alcohol-attributable deaths accounted for an estimated 20.3% of total deaths among adults 20 to 49 years of age. By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to a high of 21.7% in New Mexico. Findings suggest that alcohol-attributable deaths were responsible for 1 in 8 deaths among adults 20 to 64 years of age, and 1 in 5 deaths among adults 20 to 49 years of age. The authors suggest that these death rates could be reduced with increased implementation of evidence-based policies, such as increasing alcohol taxes or regulating alcohol outlet density.
 
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Lead Story: Association Between Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex Among US Adults

Association Between Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex Among US Adults
 
JAMA Network Open
Using data from the U.S. National Health Interview Survey, this study looked at the association, by race, ethnicity, and sex, of cigarette smoking and cessation with all-cause/cause-specific mortality. Comparing those who quit smoking before age 45 years with never-smokers, all-cause mortality rate ratios (RRs) were noted in the following groups: 1.15 Hispanic, 1.16  non-Hispanic Black, 1.11 non-Hispanic White, and 1.17 other non-Hispanic persons. Current smoking was associated with substantial excess mortality in all groups. Quitting smoking before age 45 years was associated with close to 90% reduction in the excess mortality risk associated with continued smoking; quitting at ages 45-64 years was associated with a 66% risk reduction irrespective of race and ethnicity. 
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Lead Story: Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada

Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada 
JAMA Network Open
With the emergence of the COVID-19 pandemic, physicians face specific occupational stressors, including a potentially greater risk of exposure to SARS-CoV-2, with consequent concerns over personal health and infecting family, friends, and colleagues; inadequate personal protective equipment; rapid practice changes including loss of income; and high, and at times overwhelming, workloads. In this population-based cohort study of 34,055 physicians in Ontario, Canada, the rate of outpatient visits for mental health and substance use increased on average by 13% per physician during the first 12 months of the pandemic compared with the prior 12 months. These findings suggest that the COVID-19 pandemic is associated with greater mental health services use among physicians.
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Lead Story: National trends of suicidal ideation and mental health services use among US adults with opioid use disorder, 2009–2020

National trends of suicidal ideation and mental health services use among US adults with opioid use disorder, 2009–2020 
eClinicalMedicine 
National Survey on Drug Use and Health (NSDUH) data were used to examine trends in suicidal ideation (SI) between 2009 and 2020 among adults aged 18 or older with OUD. From 2009 to 2020, the prevalence of individuals with OUD who reported SI increased significantly from 22.8% to 29.8%. The subgroups with the most significant changes included young adults, females, non-Hispanic whites, working full-time, individuals with Medicaid, living in a large metropolitan areas, and having another SUD. Among those with past-year OUD, over half with SI reported needing mental health treatment in the past year but not receiving it.
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