This Week in Addiction Medicine from ASAM

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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Lead Story: Impact of COVID-19 Telehealth Policy Changes on Buprenorphine Treatment for Opioid Use Disorder

Impact of COVID-19 Telehealth Policy Changes on Buprenorphine Treatment for Opioid Use Disorder
American Journal of Psychiatry
This was a national retrospective cohort study with interrupted time-series analyses that examined the impact of policy changes in March 2020 on buprenorphine treatment for OUD in the Veterans Health Administration, during the year before the start and during the first year of the COVID-19 pandemic. Also examined were trends in the use of telephone, video, and in-person visits for buprenorphine treatment and a comparison of patient demographic characteristics and retention in buprenorphine treatment across the two periods. The number of patients receiving buprenorphine continued to increase after the COVID-19 policy changes, but the delivery of care shifted to telehealth visits, suggesting that any reversal of COVID-19 policies must be carefully considered.
 
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Lead Story: Associations of Cannabis Potency with Mental Ill Health and Addiction: A Systemic Review

Associations of cannabis potency with mental ill health and addiction: a systemic review
The Lancet Psychiatry
Cannabis potency, defined as the concentration of Δ9-tetrahydrocannabinol (THC), has increased internationally, which could increase the risk of adverse health outcomes for cannabis users. This is the first systematic review of the association of cannabis potency with mental health and addiction. Overall, use of higher potency cannabis, relative to lower potency cannabis, was associated with an increased risk of psychosis and Cannabis Use Disorder (CUD). Evidence varied for depression and anxiety. The association of cannabis potency with CUD and psychosis highlights its relevance in health-care settings and for public health guidelines and policies on cannabis sales. Standardization of exposure measures and longitudinal designs are needed to strengthen the evidence of this association.
 
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Lead Story: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020

Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020 🔓
CDC Morbidity and Mortality Weekly Report
This CDC report shows that as overdose deaths exploded during the pandemic, racial disparities widened.  Specifically, while overall overdose deaths increased by 30% from 2019 to 2020, rates spiked much more among Black, American Indian, and Alaska Native populations than among white, Asian/Pacific Islander, and Hispanic people. Overdose deaths had been rising for decades before the pandemic, and they continued to climb into 2021, reaching more than 107,000 that year. Disparities were emerging in the pre-pandemic years and are expected to keep growing without concentrated efforts to stem them. Not surprisingly, the deaths were broadly driven by illicit fentanyl, though deaths attributed to other drug types, including stimulants like methamphetamine, have also been rising in recent years. The vast majority of people who died did not have evidence of past treatment for substance use disorder. White people who died appeared to have higher rates of treatment than people of other races and ethnicities.
 
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Lead Story: Preaddiction—A Missing Concept for Treating Substance Use Disorders

Preaddiction—A Missing Concept for Treating Substance Use Disorders
JAMA Psychiatry
This opinion piece calls for intervention with mild to moderate SUD (as defined by DSM V) to interrupt the progression to severe SUD. They suggest the term preaddiction, similar to the concept of prediabetes. Engaging the public in screening and intervening with prediabetes has succeeded in halting progression. For SUD, existing interventions, such as screening and brief intervention and computerized cognitive behavioral therapy could be used. However, they expect a range of medications and social support services will also be needed. It will be necessary for medical and nursing schools to teach recognition and management of SUDs and for there to be adequate reimbursement for these interventions. The example of prediabetes demonstrates that an early intervention program can be effective.
 
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Lead Story: Laws for expanding access to medications for opioid use disorder: a legal analysis of 16 states & Washington D.C

Laws for expanding access to medications for opioid use disorder: a legal analysis of 16 states & Washington D.C
The American Journal of Drug and Alcohol Abuse
This qualitative analysis identified and categorized state MOUD-related statutes and regulations in a random sample of four geographic locations covering 16 states and Washington D.C. The policies that appear to expand MOUD access fall within six policy domains: 1) expanding the availability of waivered buprenorphine providers, 2) expanding MOUD awareness, 3) criminal justice, 4) licensed SUD facilities, 5) insurers, and 6) hospitals. Some states appear to have taken more substantial policy efforts than others toward MOUD expansion, rather than conducting needs assessments or expanding educational opportunities for patients/providers. The authors identified several frontiers where laws are changing in ways that could potentially translate to better access to care.
 
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Lead Story: Reducing Opioid Use Disorder and Overdose Deaths in the United States: A Dynamic Modeling Analysis

Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis  
Science Advances
Since 1999, nearly 650,000 Americans have died of an opioid overdose. More than half of these deaths have occurred since 2016 due to increasing misuse of prescription opioids, followed by heroin, and now synthetic opioids such as illicitly manufactured fentanyl. This study used a system dynamics simulation model of the US opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. 
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Lead Story: Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering

Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering 🔓
JAMA Network Open
In this cohort study, 19,377 patients experienced opioid dose tapering from 2008 to 2017; this, after a 12-month baseline period of stable daily dosing of 50 morphine milligram equivalents or higher. The authors hypothesized that tapered patients would have reduced rates of study outcomes during the postinduction period. However, rates of withdrawal, overdose, and mental health crises each increased significantly in the postinduction period. These findings suggest that elevated risks of overdose and mental health crisis may persist for up to 2 years after taper initiation. Patients prescribed higher doses may benefit from more intensive support and monitoring, particularly for depression and suicidality.
 
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