This Week in Addiction Medicine from ASAM

Barriers to Buprenorphine Initiation in Patients Using Fentanyl JAMA Network Open This is a survey study of 396 buprenorphine-prescribing clinicians in the US to determine if they faced problems initiating buprenorphine among patients using fentanyl, and whether their practice had changed as a result. Participants were selected from a stratified random sample of X-waivered clinicians registered wi...

Productivity Losses From Substance Use Disorder in the U.S. in 2023 American Journal of Preventive Medicine Information on morbidity-related productivity losses attributable to substance use disorder is limited. This study estimates morbidity-related productivity losses attributable to substance use disorder among U.S. adults aged ≥18 years in 2023. It found that total morbidity-related productivi...

Expanding Access to Buprenorphine and Methadone: Global Perspectives and Policy Recommendations Substance Use and Addiction Journal This is a narrative review of methadone and buprenorphine regulations, prescriber eligibility, dispensing models, and coverage across eight countries: the United States, Canada, the United Kingdom, Russia, France, Iran, Australia, and Portugal. The study identified se...

Very Low Nicotine Content Cigarettes for Smoking Cessation: Examining a Facilitated Extinction Approach and Dosing Schedule Drug and Alcohol Dependence Very low nicotine cigarettes (VLNC, 0.4 mg nicotine/g tobacco) have been shown to reduce smoking behavior when compared to normal nicotine cigarettes (NNC,17 mg nicotine/g tobacco). Participants (n=208) were randomly assigned to 4 experimental grou...

Fatal Opioid Overdoses by Historical and Contemporary Neighborhood-Level Structural Racism 🔓 JAMA Health Forum  This cross-sectional study of 796 census tracts prior to the COVID-19 pandemic (2017-2019) and 792 census tracts during the COVID-19 pandemic (2020-2022) in Chicago, Illinois, assessed the extent to which there is a spatial association between neighborhood-level structural racism and op...

State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015–23 Health Affairs While medications for opioid use disorder (MOUD) is effective treatment, most patients with OUD don’t receive it and prior authorization (PA) has been a barrier to access. Researchers looked at state policies trying to address this barrier, specifically for private health...

Rapid vs Standard Induction to Injectable Extended-Release Buprenorphine JAMA Network This industry-sponsored, multicenter, open-label randomized clinical trial with 729 participants, assessed if  rapid induction (RI) for initiating extended-release buprenorphine is as safe and effective as standard induction (SI) in individuals who inject opioids or use fentanyl.  RI was well tolerated and had hi...

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...

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 th...

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...

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 an...

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 lat...

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 canna...

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 str...

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 fenta...

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) implement...

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, t...

Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting   JAMA Network Open  Injectable-only buprenorphine protocols are an exciting new strategy for buprenorphine initiation, particularly in the fentanyl era. This is a cohort study of 95 patients with moderate to severe opioid use disorder who received care in a low-threshold setting in Seattle. 79% of patients incl...

Association between housing status and mental health and substance use severity among individuals with opioid use disorder and co-occurring depression and/or PTSD   BMC Primary Care  This is a cross-sectional analysis of associations between housing status and mental health and substance use severity among primary care patients with co-occurring disorders. The study is a sub-analysis using data fr...

Oral methadone versus sublingual buprenorphine for the treatment of acute opioid withdrawal: A triple-blind, double-dummy, randomized control trial   Drug and Alcohol Dependence Researchers compared oral methadone to sublingual buprenorphine for the management of acute opioid withdrawal. Patients at an inpatient drug treatment center in India were randomly assigned to receive either methadone or b...

Implementation Gaps in US Syringe Service Programs, 2022   JAMA  This study performed a cross-sectional analysis of the Syringe Services Programs in the US (SSPUS) dataset to determine implementation gaps. 613 syringe service programs (SSPs) included in the dataset were geocoded to county boundaries, which were then analyzed for urbanicity and SSP need (based on HCV mortality, HIV incidence, and d...

Co-involvement of stimulants with opioids in North America: A 'silent epidemic’ Plos Mental Health The opioid epidemic unfolded in three distinct waves, with the latest being deaths attributed to illegally manufactured synthetic opioids. Using U.S. and Canadian data, this study reviews evidence for a 'silent epidemic' alongside the opioid epidemic that is characterized by the co-ingestion of stimu...

Did alcohol facilitate the evolution of complex societies?   Humanities and Social Sciences Communications This study tested the “drunk” hypothesis, which claims that alcohol promoted social bonding and cooperation, aiding the rise of complex societies. Using data from 186 non-industrial societies, they found a modest positive link between indigenous alcoholic beverages and political complexity, e...

Disparities in Treatment and Referral After an Opioid Overdose Among Emergency Department Patients   JAMA Network Open This cohort study of 1,683 patients assessed if there are racial and ethnic disparities in treatment referral rates among patients in the emergency department (ED) with opioid overdose.  It found a statistically significant difference in the proportion of Black patients who receiv...

Prescriber-Level Changes in Buprenorphine Dispensing in the USA Before and After Federal Policy Changes Aimed at Increasing Prescribing Journal of General Internal Medicine This study used interrupted-time-series analysis to model prescriber-level trends in buprenorphine prescriptions after recent federal policy changes.  It found that the elimination of the waiver requirement to prescribe bupreno...