This Week in Addiction Medicine from ASAM

Lead: States With Substantial Increases In Buprenorphine Uptake Did So With Increased Medicaid Prescribing, 2018–24

States With Substantial Increases In Buprenorphine Uptake Did So With Increased Medicaid Prescribing, 2018–24
Health Affairs
Multiple federal policy changes since 2018 intended to increase buprenorphine prescribing in response to a persistent treatment gap for opioid use disorder (OUD) in the US. Anticipated national increases did not occur, but highly variable state-level trends provide important insights. This study used IQVIA data to examine all-payer and per payer prescribing across states during the period 2018–24.  Researchers found that highly disparate state-level changes suggest that federal policy impacts were mediated by state-specific factors. Medicaid’s key role in driving overall prescribing highlights the public health urgency of maintaining expansions and sustaining enrollment for the single adult population. 
 
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Lead: Ultra-processed food addiction in a nationally representative sample of older adults in the USA

Ultra-processed food addiction in a nationally representative sample of older adults in the USA 
Addiction
Using a cross-sectional online and telephone survey of a nationally representative sample of older adults (aged 50–80 years) in the US, this study examined the prevalence of ultra-processed food addiction (UPFA) in older US adults and its association with various health domains.  It found that ultra-processed food addiction appears to be prevalent among older adults in the US, particularly among women who were in adolescence and early adulthood when the nutrient quality of the US food supply worsened. Addictive patterns of UPF intake appear to be associated with poorer physical health, mental health, and social well-being.
 
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Lead: Alcohol Consumption Per Capita and Suicide: A Meta-Analysis

Alcohol Consumption Per Capita and Suicide: A Meta-Analysis
JAMA Network Open 
This meta-analysis that included 13 studies assessed if alcohol consumption per capita is associated with suicide mortality and, if so, does the association differ by sex. Researchers found that a 1-L increase in alcohol consumption per capita was associated with a 3.59% increase in the suicide mortality rate. There was no evidence of a sex difference in this association. These findings suggest alcohol consumption per capita may be a useful target to consider within comprehensive national suicide prevention strategies. 
 
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Lead: Measures of General Intelligence and Risk for Alcohol Use Disorder

Measures of General Intelligence and Risk for Alcohol Use Disorder
JAMA Psychiatry
This male Swedish cohort study that included 573,855 participants assessed if there is an association between IQ and risk for alcohol use disorder, and if so, what is the nature of this association.  It found that IQ at age 18 years was associated with subsequent alcohol use disorder risk. Mendelian randomization analyses suggest a causal association, albeit with context-dependent differences; genetic liability for cognitive performance also predicted alcohol use disorder in a US-based sample. Results suggest that there was a clear impact of genetic liability for cognitive performance on alcohol disorder risk, but the association varies based on the sociocultural context.
 
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Lead: Medications for Opioid Use Disorder Playbook

Medications for Opioid Use Disorder Playbook
Agency for Healthcare Research and Quality (AHRQ) 
The AHRQ Integration Academy developed the Medications for Opioid Use Disorder Playbook as a practical guide for providing medications for opioid use disorder (MOUD) and immediate care for patients with OUD in primary care and other ambulatory care settings. It is interactive, web-based, and has the latest guidance, tools, resources, and examples that address key aspects of MOUD implementation. The MOUD Quick Start Guide covers the essentials of low-threshold care, while the balance of the Playbook offers more in-depth resources and guidance for those practices interested in working toward more comprehensive, whole-person care. The low-threshold approach ensures immediate access to MOUD, eliminating barriers for both patients and providers. 
 
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Lead: Cannabis Use During Pregnancy and Lactation

Cannabis Use During Pregnancy and Lactation
American College of Obstetricians & Gynecologists
Cannabis is the most commonly used illicit drug under U.S. federal law. With increasing social acceptability, accessibility, and legalization in many states, the prevalence of cannabis use among pregnant and lactating individuals has increased significantly. Substance use in pregnancy, including cannabis use, has been associated with adverse outcomes such as spontaneous preterm birth, low birth weight, and developmental delay. Clinicians should be aware of the possibility of pregnant and lactating patients' use of cannabis and be prepared to counsel and screen all patients and use evidence-based strategies to reduce cannabis use.  These include supportive home visits, psycho-behavioral strategies, or brief electronic or text messaging interventions to reduce cannabis use in pregnancy and the postpartum period to promote parental and newborn health.
 
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Lead: Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study

Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study
American Journal of Psychiatry
This national retrospective cohort study found that veterans with stimulant use disorder who received contingency management (CM) were 41% less likely to die in the year following treatment initiation relative to matched comparison subjects. These findings provide the strongest real-world evidence to date that CM is associated with reduced all-cause mortality, underscoring its potential as a life-saving intervention in routine care. Results support expanding access to CM across healthcare systems and public health settings.
 
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Lead: Machine learning– and multilayer molecular network–assisted screening hunts fentanyl compound

Machine learning– and multilayer molecular network–assisted screening hunts fentanyl compounds
Science Advances
Fentanyl and its analogs are a global concern, making their accurate identification essential for public health. This article introduces Fentanyl-Hunter, a screening platform that uses a machine learning classifier and multilayer molecular network that covers more than 87% of known fentanyls to select and annotate fentanyl compounds using mass spectrometry (MS). Fentanyl-Hunter identified fentanyl members in biological and environmental samples. During biotransformation, 35 metabolites from four widely consumed fentanyl derivatives were identified. Norfentanyl was the major fentanyl compound in wastewater. Retrospective screening of these biomarkers across more than 605,000 MS files in public datasets revealed fentanyl, sufentanil, norfentanyl, or remifentanil acid in more than 250 samples from eight major countries, indicating the potential widespread presence of fentanyl.
 
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Lead: Evaluation of a Novel Patient-Centered Methadone Restart Protocol

Evaluation of a Novel Patient-Centered Methadone Restart Protocol 🔓
JAMA Network Open
Restarting methadone for patients who have had a gap in treatment is often a frustratingly slow process for both the patient and provider. This cohort study of individuals examined outcomes for patients of a public, safety-net opioid treatment program before (n=786 patients) and after (n=780 patients) implementation of a 2022 clinical protocol focused on individualized methadone restart doses based on opioid tolerance. Preimplementation restart doses were 32.8% lower than the last prior methadone dose, whereas postimplementation restart doses were only 3.4% lower than the last prior methadone dose. There was no significant change in patient safety (emergency department visits within 7 days after restart and all-cause mortality within 7 and 90 days after restart) or 90-day retention in care.
 
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Lead: Recommendations for Addressing In-Hospital Substance Use From a National Delphi Consensus Process

Recommendations for Addressing In-Hospital Substance Use From a National Delphi Consensus Process
JAMA Network Open
This survey study utilized a 3-round Delphi consensus process to identify best practices for addressing in-hospital substance use. A panel of 38 addiction experts developed 84 consensus-based and patient-centered recommendations which can inform local responses, including policies, to address in-hospital substance use. 
 
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