This Week in Addiction Medicine from ASAM

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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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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