This Week in Addiction Medicine from ASAM

Lead Story: Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder

Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder
JAMA Psychiatry
In this case-control study of 34,505 Medicare beneficiaries, patients had greater risk of experiencing an opioid overdose and higher health care expenditures in buprenorphine treatment gap months compared with treated months. Buprenorphine nonadherence is associated with an increased risk of opioid overdose and higher health care spending in Medicare.
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Lead Story: Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services

Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services
Annals of Emergency Medicine
Initiation of buprenorphine in emergency departments (EDs) after opioid overdose is increasing, but many patients seen by emergency medical services (EMS) in the field refuse transport to the ED or leave the ED prior to evaluation. This study evaluated a program in which EMS was able to provide buprenorphine to patients in the field after opioid overdose, along with a same or next-day appointment in a substance use disorder clinic. Patients evaluated by EMS units with buprenorphine were significantly more likely to engage in treatment within 30 days (OR 5.62) than those evaluated by non-buprenorphine units. In addition, those evaluated by EMS units with buprenorphine who received buprenorphine were significantly more likely to engage in treatment (OR 12.83) than those who did not. There were no significant differences in subsequent opioid overdoses between groups. 
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Lead Story: Estimating the Prevalence of Substance Use Disorders in the US Using the Benchmark Multiplier Method

Estimating the Prevalence of Substance Use Disorders in the US Using the Benchmark Multiplier Method
JAMA Psychiatry
In this cross-sectional study, using the benchmark multiplier method and Medicaid administrative data in combination with data from the National Survey on Drug Use and Health for 2018 and 2019, the 12-month prevalence estimates of alcohol use disorder, cannabis use disorder, opioid use disorder, and stimulant use disorder were higher than estimates from the National Survey on Drug Use and Health. The findings suggest that the prevalence of substance use disorders may be considerably higher than National Survey on Drug Use and Health estimates indicate.
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Lead Story: Association of State Child Abuse Policies and Mandated Reporting Policies With Prenatal and Postpartum Care Among Women Who Engaged in Substance Use During Pregnancy

Association of State Child Abuse Policies and Mandated Reporting Policies With Prenatal and Postpartum Care Among Women Who Engaged in Substance Use During Pregnancy
JAMA Pediatrics
Certain states have enacted policies that consider substance use during pregnancy as child abuse. In this cross-sectional study of 4,155 pregnant women who engaged in substance use during pregnancy, 33.9% delivered in states with a child abuse policy only, 16.4% in states with a mandated reporting policy only, 32.9% in states with both policies, and 16.8% in states with neither policy. Women who delivered in states with a child abuse policy only, mandated reporting policy only, or both policies initiated prenatal care later, with a reduced chance for adequate prenatal and postnatal care compared with women who delivered in states without these policies. Such policies may deter pregnant people who engage in substance use from receiving the essential care and treatment they deserve.
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Lead Story: Association of Mental Health Burden With Prenatal Cannabis Exposure From Childhood to Early Adolescence

Association of Mental Health Burden With Prenatal Cannabis Exposure From Childhood to Early Adolescence
JAMA Pediatrics
In this study, the authors credit longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study and investigate whether associations with psychopathology last into early adolescence and past middle childhood. Prenatal Cannabis Exposure (PCE) was found to be associated with lasting vulnerability to psychopathology throughout early adolescence, and this did not change with age. Evidence that the impact of PCE on psychopathology does not improve as children enter adolescence is further warning against the use of this substance in pregnancy.
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Lead Story: Thirty Years of The ASAM Criteria: A Report Card

Thirty Years of The ASAM Criteria: A Report Card
Psychiatric Clinics of North America
The ASAM Criteria® – the sophisticated system for organizing treatment services and settings with patient care decision rules – defined the infrastructure of addiction care, the types and intensity of treatment, staffing, and service provision for each level of care. For more than 30 years, this led to a national standard in addiction treatment and a leadership role in behavioral health. Beyond the ASAM Criteria, there is ASAM CONTINUUMTM software and the ASAM–CARF Level of Care (LOC) Certification Program, affording a common language and process for improving care. The authors have constructed a report card given the history of the Criteria, with plans for improvement.
 
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Lead Story: Receipt of Telehealth Services for OUD

Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic
JAMA Psychiatry
During the COVID-19 pandemic, emergency authority allowed expanded telehealth services for MOUD as well as increased take home doses of methadone at OTPs. This study used data from the US Centers for Medicare & Medicaid Services regarding telehealth services for OUD, retention in treatment, and medically treated overdoses. Telehealth services for OUD increased significantly during the pandemic to 20% of beneficiaries compared to 0.6% prepandemic. Receipt of telehealth services was associated with increased MOUD retention (aOR 1.27) and reduced medically treated overdose (aOR 0.67). MOUD (mostly methadone) from an OTP increased during the pandemic to 4.0% from 1.4% prepandemic. The authors conclude that the improved retention and decrease in overdoses associated with telehealth support making these emergency changes permanent.
 
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Lead Story: Marijuana and hallucinogen use among young adults reached all time-high in 2021

Marijuana and hallucinogen use among young adults reached all time-high in 2021 
NIDA
2021 MONITORING THE FUTURE PANEL STUDY ANNUAL REPORT 
Monitoring the Future
Since 1975, the Monitoring the Future study has annually surveyed substance use behaviors and attitudes among a nationally representative sample of teens. As reported by young adults, marijuana and hallucinogen use in the past year increased significantly in 2021, reaching historic highs in this age group since 1988. Rates of past-month nicotine vaping also continued their general upward trend in 2021, despite leveling off in 2020. Past-month marijuana vaping rebounded to pre-pandemic levels in 2021. Alcohol remains the most used substance among adults in the study. Binge drinking (five or more drinks in a row in the past two weeks) rebounded in 2021 from a historic low in 2020, during the early stages of COVID-19 pandemic. In 2021, high-intensity drinking (having 10 or more drinks in a row in the past two weeks) reached its highest level ever recorded since first measured in 2005.
 
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Lead Story: Neurocognitive Performance and Brain Structure Associated With Initiation of Tobacco Use

Longitudinal Assessments of Neurocognitive Performance and Brain Structure Associated With Initiation of Tobacco Use in Children, 2016 to 2021 
JAMA Network Open
Data from the Adolescent Brain and Cognitive Development (ABCD) study was analyzed to assess impact of early initiation (

Lead Story: Adolescent Use of Flavored Non-Tobacco Oral Nicotine Products

Adolescent Use of Flavored Non-Tobacco Oral Nicotine Products 
Pediatrics
Prevalence of non-tobacco oral nicotine product use among adolescents is unknown. This study calculated prevalence of ever and past 6-month use of nicotine pouches, other non-tobacco oral nicotine products, e-cigarettes, cigarettes, hookah or waterpipe, cigars, cigarillos, and snus among high school students in Southern California between September and December 2021. Generalized linear mixed models tested associations of sociodemographic factors and tobacco-product use with use of any non-tobacco oral nicotine product. Flavored non-tobacco oral nicotine products were the second most prevalent nicotine product used by adolescents in Southern California. They were disproportionately used by certain racial and ethnic, sexual, or gender minority groups and those with a history of nicotine use.
 
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