This Week in Addiction Medicine from ASAM

Lead: Racial Inequality in Receipt of Medications for Opioid Use Disorder

Lead Story
Racial Inequality in Receipt of Medications for Opioid Use Disorder
The New England Journal of Medicine
Opioid overdose mortality has increased over the last ten years, but disproportionately among Black persons. The authors examine racial disparities in receipt of buprenorphine and naloxone after opioid use disorder (OUD) related events using Medicare data from 2016-2019. They found that Black persons were less likely to receive buprenorphine (12.7 vs 23.3%) and naloxone (14.4% vs 22.9%) than White persons within six months after the event. Further, Black persons received lower day supply of buprenorphine and were less likely to be retained on treatment. Of note, Black and White persons had similar rates of ambulatory visits in the 6 months after the event, indicating patient and provider-level barriers to access.
 
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Lead: Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal

Lead Story: 
Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal
The New England Journal of Medicine
This multicenter randomized controlled trial was undertaken to evaluate the the Eat, Sleep, Console Care Tool vs usual care for neonatal opioid withdrawal with the primary outcome being medically ready for hospital discharge. The Eat, Sleep, Console Care Tool relies on an assessment of withdrawal severity focused on an infant’s ability to eat, sleep, and be consoled, along with the use of nonpharmacologic interventions as first line of treatment. The Eat, Sleep, Console care approach decreased the time until infants with opioid withdrawal were medically ready for discharge by a mean of 6.7 days, and the proportion of infants receiving pharmacologic treatment by 32.5%. Hence, this approach facilitates more judicious use of medication for these infants.
 
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Special Episode: Buprenorphine Initiation and the Howard Street Method

Article Referenced:  
Noel, Marnie PharmD, BCPP; et all. The Howard Street Method: A Community Pharmacy-Led Low Dose Overlap Buprenorphine Initiation Protocol for Individuals Using Fentanyl. Journal of Addiction Medicine.
 
ASAM Resources: 
2020 National Practice Guideline for the Treatment of Opioid Use Disorder 
OUD Treatment Education 
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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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