This Week in Addiction Medicine from ASAM

Lead: Trends in hallucinogen-associated emergency department visits

Trends in hallucinogen-associated emergency department visits and hospitalizations in California, USA, from 2016 to 2022 🔓
Addiction
There has been growing interest in recent years around hallucinogens as potential therapeutics, and use among young adults has increased significantly. With limited data, the mounting perception is that hallucinogens are safe. In this context, the authors examined emergency department (ED) visits and hospitalizations due to hallucinogens versus alcohol and cannabis in California between 2016 and 2022. Hallucinogen-associated ED visits increased by 54% (2260 visits to 3476 visits), while alcohol-associated visits decreased by 20% and cannabis-associated visits increased by 15%. Additionally, hallucinogen-associated hospital admissions increased by 55% (2556 to 3965) with no significant changes in alcohol- and cannabis-associated hospitalizations. Additional research is needed to assess hallucinogen-associated potential harms. 
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Lead: Adolescent Residential Addiction Treatment In The US

Lead Story:
Adolescent Residential Addiction Treatment In The US: Uneven Access, Waitlists, And High Costs
Health Affairs
Residential treatment facilities are one treatment option for adolescents with substance use disorders, yet little is known about their accessibility or cost. This study identified 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. Eighty-seven facilities (54.4 percent) had a bed immediately available. Among sites with a waitlist, the mean wait time for a bed was 28.4 days. Of facilities providing cost information, the mean cost of treatment per day was $878. Daily costs among for-profit facilities were triple those of nonprofit facilities. Half of facilities required up-front payment by self-pay patients. The mean up-front cost was $28,731. The authors were unable to identify any facilities for adolescents in ten states or Washington, D.C. Access to adolescent residential addiction treatment centers in the United States is limited and costly.
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Lead: Benzodiazepine Discontinuation and Mortality

Lead Story:
Benzodiazepine Discontinuation and Mortality Among Patients Receiving Long-Term Benzodiazepine Therapy 
JAMA Network Open
In this comparative effectiveness study among 353,576 patients receiving stable long-term treatment with benzodiazepines, discontinuation was associated with small absolute increases in mortality and other potential harms, including nonfatal overdose, suicide attempt, suicidal ideation, and emergency department visits. These results suggest benzodiazepine discontinuation among patients prescribed for stable long-term treatment may be associated with unanticipated harms, and that efforts to promote discontinuation should carefully consider the potential risks of discontinuation relative to continuation.
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ASAM Weekly Top 10 Peer reviewed Scientific Publications of 2023

Top Publication of 2023:
ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids 🔓
Journal of Addiction Medicine
This clinical considerations document is based on a narrative literature review and expert consensus and addresses considerations for changes to the clinical practice of treatment of opioid use disorder (OUD) with buprenorphine for individuals using high-potency synthetic opioids (HPSOs). Broadly, it suggests that individualized strategies for buprenorphine initiation may be needed. The experience of opioid withdrawal negatively impacts the success of buprenorphine treatment, and attention to withdrawal management before and during buprenorphine initiation should be proactively addressed. Buprenorphine dose and dosing frequency should be individualized based on patients’ treatment needs, the possibility of novel components in the drug supply should be considered during OUD treatment, and all forms of opioid agonist treatment should be offered and considered for patients.
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Lead: Examining the benefit of a higher maintenance dose of extended-release buprenorphine

Lead Story:
Examining the benefit of a higher maintenance dose of extended-release buprenorphine in opioid-injecting participants treated for opioid use disorder 
Harm Reduction Journal 
This is a secondary analysis of a randomized, double-blind study comparing 100 mg and 300 mg maintenance doses of extended-release buprenorphine (BUP-XR). All patients (n=311) received 2 monthly induction doses of 300 mg BUP-XR followed by 4 monthly maintenance doses of either 100 mg or 300 mg BUP-XR. For patients who had not been using opioids by injection, there was no difference in weekly abstinence or treatment retention comparing the two maintenance doses. However, for patients with a history of injecting opioids, the 300 mg maintenance dose resulted in significantly higher percentages of weeks abstinent as well as improved treatment retention. The authors speculated that opioid injecting patients may have had higher levels of tolerance that required a higher maintenance dose.
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Lead: Relationship between alcohol use and firearm-involved suicide

Lead Story: 
Relationship between alcohol use and firearm-involved suicide: Findings from the National Violent Death Reporting System, 2003-2020
American Journal of Preventive Medicine
This study evaluated the sex- and age group-specific relationship between alcohol intoxication and firearm-involved suicide. Among males of all ages and young and middle-aged females, alcohol intoxication was associated with increased risk of suicide by firearm, an extremely lethal method that accounts for a majority of suicides in the US, compared to their non-intoxicated counterparts. Interventions targeting excessive alcohol consumption may be effective in reducing suicide mortality rates
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Lead: Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic

Lead Story:
 
Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic
JAMA Psychiatry
This cross-sectional exploratory study examined knowledge gaps in overdose deaths among pregnant and postpartum persons from 2018-2021 as compared to nonpregnant overdose deaths and obstetrical deaths. Overdose deaths among pregnant and postpartum women consistently increased among those aged 10 to 44 years, and more than tripled among those aged 35 to 44 years, from 4.9 per 100,000 from January-June 2018 to 15.8 from July-December 2021. These deaths differed from nonpregnant overdose deaths and obstetrical deaths in sociodemographic characteristics and place of death. Among overdose deaths in total (pregnant and nonpregnant), nearly 75% occurred outside of health care settings. Clearly more work needs to be done to treat SUDs in this population. 
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Lead: 2022 National Survey on Drug Use and Health

Lead Story:
2022 National Survey on Drug Use and Health (NSDUH) 
SAMHSA 
Key findings include that in 2022, 70.3 million people aged 12 or older (or 24.9%) used illicit drugs in the past year. Marijuana was the most used illicit drug, with 22.0% of people aged 12 or older (or 61.9 million people) using it in the past year. In 2022, 48.7 million people aged 12 or older (or 17.3%) had a substance use disorder (SUD) in the past year, including 29.5 million who had an alcohol use disorder (AUD), 27.2 million who had a drug use disorder (DUD), and 8.0 million people who had both an AUD and a DUD. Almost 1 in 4 adults aged 18 or older had any mental illness (AMI) in the past year (59.3 million or 23.1%) and among adolescents aged 12 to 17 in 2022, 19.5% (or 4.8 million people) had a past year major depressive episode (MDE).
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Lead: Fast dopamine increases drug reward

Lead Story:
Neural circuit selective for fast but not slow dopamine increases in drug reward🔓
Nature Communications
The authors note that rapid delivery to the brain when drugs are injected or smoked results in more severe substance use disorders. They used functional MRI and PET scans to monitor dopamine increases while subjects (n=20) received methylphenidate either orally or intravenously. Intravenous methylphenidate caused a more rapid increase in dopamine than oral. Activity in the medial prefrontal cortex decreased in both groups but was more pronounced with intravenous methylphenidate. However, only intravenous methylphenidate produced increased activity in the dorsal anterior cingulate cortex and insula that was reflected in the subjective rating of “high.”  This brain region was activated only by intravenous methylphenidate and the associated rapid increase in dopamine.
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Lead: Public health approaches to gambling

Lead Story:
Public health approaches to gambling: a global review of legislative trends 
The Lancet Public Health
Authors of this article systematically reviewed legislation of jurisdictions that introduced major gambling legislation change (i.e., restricting or extending gambling provision) between Jan 1, 2018, and Dec 31, 2021. More than 80% of countries worldwide now legally permit gambling. Harmful gambling was recognized as a health and wellbeing issue in most of the analyzed jurisdictions, but near-exclusive focus was given to individual-level harms rather than to wider social and economic harms or harms to others. Most of the proposed prevention measures focused on individual responsibility. Gambling policies worldwide are changing, but addressing gambling as a public health issue has not yet translated into comprehensive policy action across jurisdictions.
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