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The expanded scope of the Medicaid program has accomplished a great deal in bolstering substance use treatment, but further progress will depend on correcting deficiencies in non‐expansion states and within Medicaid managed care entities, a newly published commentary suggests. [ABSTRACT FROM AUTHOR]

Last week, ADAW featured a published paper recommending that higher doses of buprenorphine be used in the era of fentanyl (see "ASAM recommends higher doses if needed for treatment with buprenorphine," ADAW, Jan. 7, 2024, https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.33984). The American Society of Addiction Medicine (ASAM) did not have time to get back to us by deadline but did respond to our questions for this week's issue. Below are our questions, in italics, followed by their responses. [ABSTRACT FROM AUTHOR]

The article focuses on the National Bureau of Economic Research (NBER) working paper from Jennifer L. Doleac and Anita Mukherjee, which found that greater opioid abuse and opioid-related crime has resulted from laws expanding access to the overdose-rescue drug naloxone. According to the study, there is no evidence that naloxone leads more people to search for fentanyl.

As Scott E. Hadland, M.D., senior author of a dramatic paper published last week in the New England Journal of Medicine puts it, drug use among adolescents is not getting more common — it's at its lowest in almost 50 years. But it's getting more deadly, due to fentanyl. In "The Overdose Crisis among U.S. Adolescents," by Hadland and lead author Joseph Friedman, Ph.D., the problem is laid out clearly: After guns and car crashes, overdose (OD) deaths are now the third leading cause of death among adolescents. [ABSTRACT FROM AUTHOR]

At least on paper, the early actions of New York state regulators in establishing a recreational marijuana marketplace are checking multiple boxes in progressive policy: Counteracting the ills of the war on drugs, boosting people of color in obtaining dispensary licenses, even ensuring less environmentally noxious cultivation. What remains much less clear is whether the state's regulations governing adult use of cannabis will be strong enough to deter such harms as greater youth access, and to what degree wider availability of the drug will fuel intensified demand for treatment. [ABSTRACT FROM AUTHOR]

Even in service settings that accept the use of methadone and buprenorphine as part of treatment, stigmatizing attitudes toward the medications' role can result in treatment decisions that conflict with medical guidelines, suggests a paper based on interviews with providers and drug users. The authors suggest that these views are shaped in part by some providers' mistrust of patients with opioid use disorder (OUD) and their own experiences with non‐agonist paths to recovery. Methadone is a full opioid agonist; buprenorphine is a partial agonist. [ABSTRACT FROM AUTHOR]

A policy paper released this month by the American Association for the Treatment of Opioid Dependence (AATOD) focuses on some of the challenges facing opioid treatment programs (OTPs) today. For example, it cites an article published in the New England Journal of Medicine (July 5, 2018) by Michael Botticelli that promotes the idea of methadone being available in primary practice settings for the treatment of opioid use disorder (OUD) (see ADAW, July 16, 2018). "AATOD recommends that this proposal should only be considered after careful, conservative, and thoughtful evaluation," according to the policy paper. "As history and our policies have shown, we do not reject the public health model for increasing access to care for OUD, nor are we ignoring what has been learned about clinical standards of care to treat this illness. It is important to understand, however, the complexity of inducting a new patient into methadone maintenance treatment when developing policies for increasing access to medication assisted treatment." [ABSTRACT FROM AUTHOR]

A newly released study suggests that economic impact payments to individuals during the pandemic might have contributed to a surge in opioid overdose deaths, but the results are being portrayed to the public as having a much more dramatic impact. While the study paper from researchers at Bowling Green State University clearly states that the results don't indicate that the payments caused the rise in deaths, language in a news release from the Ohio Attorney General's Office implies a cause‐and‐effect relationship. [ABSTRACT FROM AUTHOR]

Last week's issue featured the announcement of a new payment model for addiction treatment, a combination of capitated and bundled reimbursement that places the treatment provider at risk in the event of repeat admissions. Greg Williams, executive vice president of Facing Addiction with NCADD, described the rationale for the system: Treatment providers should not be paid if patients don't get well. Anne Marie Polak, senior director at Leavitt Partners and in charge of the “Incentivizing Recovery” project the organization is convening, described the basics of how the project works. None of the treatment organizations participated in the project, which resulted in the white paper released Sept. 7 (see ADAW, Sept. 17). [ABSTRACT FROM AUTHOR]

There have been many calls for federal changes to address the opioid epidemic, but one from Beau Kilmer, senior policy researcher and director of the Drug Policy Research Center at the RAND Corporation, released last week is a particularly interesting distillation that doesn't omit pros and cons for each strategy. [ABSTRACT FROM AUTHOR]

From 2017 – 2022, law enforcement seizures across the United States of mushrooms containing psilocybin increased dramatically, according to a new study funded by the National Institute on Drug Abuse (NIDA). The number of law enforcement seizures increased from 402 seizures in 2017 to 1,396 in 2022. In addition, the total weight of psilocybin mushrooms seized by law enforcement increased from 226 kg (498 lbs.) seized in 2017 compared with 844 kg (1,861 lbs.) in 2022. This analysis, published in Drug and Alcohol Dependence, was led by researchers at New York University (NYU) Langone Health in New York City, and the University of Florida, Gainesville. The data used for the analysis were collected through the High Intensity Drug Trafficking Areas (HIDTA) program, a grant program aimed at reducing drug trafficking and misuse administered by the Office of National Drug Control Policy. Though law enforcement seizures do not necessarily reflect prevalence of use, they represent an indicator of the availability of illicit drugs. "We are in the middle of a rapidly evolving cultural, media, and legal landscape when it comes to psychedelics, and we need data to help shape informed and appropriate public health strategies," said NIDA Director Nora D. Volkow, M.D., in announcing the research publication last week. "Moving forward, we must continue to track data on the availability of psychedelics, patterns in use, and associated health effects to guide efforts in promoting accurate education and reducing potential harms among people who do plan to use psychedelic drugs." Adverse effects of psilocybin mushrooms, such as "bad trips," are marked by "distorted thinking, perceptual changes, putting oneself in physical danger, and intense feelings of fear, anxiety, and confusion," according to NIDA. "People who take psychedelic drugs like psilocybin may also experience short‐term side effects such as raised blood pressure and heart rate, agitation, confusion, vomiting, or nausea, which may be severe and require medical attention." Joseph J. Palamar, Ph.D., M.P.H., associate professor at the NYU Grossman School of Medicine, co‐investigator on the NIDA‐funded National Drug Early Warning System (NDEWS), and lead author on the paper, said "Research studies suggesting its effectiveness in treating mental health issues and extensive positive media coverage may lead some people to seek 'shrooms' outside of medical contexts. People who use psilocybin outside of medical supervision need to be educated about risks associated with use." [ABSTRACT FROM AUTHOR]

The primary manner by which states have been using Medicaid to expand access to substance use disorder (SUD) treatment may actually be making it more difficult for individuals to receive the services most appropriate to their needs, a newly released paper suggests. Moreover, this preferred strategy in many cases violates the law, authors with the National Health Law Program contend. [ABSTRACT FROM AUTHOR]

An over‐reliance on federal block grants and "one‐off" funding initiatives has left the addiction treatment system under‐resourced to respond to an addiction crisis that stands to be at least as deadly as COVID‐19 during the span of the Biden administration, a trio of prominent researchers argue in a newly released policy paper. The authors suggest that the new administration and Congress should prioritize efforts to build on what they consider the most impactful developments in improving access and quality in addiction treatment, such as Medicaid expansion and parity mandates. [ABSTRACT FROM AUTHOR]

Two recent research papers highlight ongoing deficiencies in the provision of addiction and mental health treatment services to veterans, though the report focusing on depression treatment for patients with substance use disorders (SUDs) suggests that shortcomings in treatment for co‐occurring disorders affect all populations. [ABSTRACT FROM AUTHOR]

A new research paper on the neurobiology of opioid addiction is replete with complex terms, such as the pivotal "hyperkatifeia" (coined about a decade ago to describe an increase in the intensity of the negative emotional signs of drug withdrawal). But the primary takeaway message from the report's author, National Institute on Alcohol Abuse and Alcoholism (NIAAA) Director George Koob, M.D., is much more accessible and direct. [ABSTRACT FROM AUTHOR]

The article presents the white paper from American Association for the Treatment of Opioid Dependence (AATOD) which focuses on how opioid treatment programs can coordinate with office-based buprenorphine prescribers.

A white paper from Canada and the United States focuses on collaboration between the two countries on their commitment to deal with the overdose crisis. "Substance Use and Harms During COVID‐19 and Approaches to Federal Surveillance and Response," issued Sept. 27, states that the increase in "substance use harms and deaths" during COVID‐19 is partly due to a decrease in access to services. The white paper itself focuses on the restrictions to methadone access in the United States and says little about the Canadian rules, but they are much more lenient. [ABSTRACT FROM AUTHOR]

Adoption of a unified public health framework for the treatment of opioid use disorders (OUDs) would encourage more continuity of care and use of evidence‐based medication treatments to combat the crisis, suggest researchers with Columbia University and the New York State Psychiatric Institute. Moreover, they state in a newly published paper, the "Cascade of Care" framework they seek to advance could be used to improve accreditation standards they believe do not sufficiently address providers that do not use methadone, buprenorphine or injectable naltrexone in their treatment of opioid addiction. [ABSTRACT FROM AUTHOR]

The article focuses on a report in an issue of the "Palm Beach Post" on the downfall of the sale of a portfolio of addiction recovery treatment centers by real estate investor Frank Cid due to alleged kickbacks, patient brokering and fraud. It cites the alleged unethical practices in patient urine testing and billing, move by Cid to sue Florida Association for Recovery Residences (FARR) president John Lehman for defamation and the impression of Lehman over the revenue source of the centers.

The article talks about the concept of civil commitment for substance use disorders (SUDs), discussing a research paper released by Hazelden Betty Ford Foundation. Topics discussed include the views of some people that addiction is a disease and its treatment should not be coerced; a paper by the U.S. National Institute on Drug Abuse (NIDA) on it; and the benefits of involuntary commitment laws for substance use disorders.

The article discusses the traditional six-month rule of demonstrated abstinence from alcohol use before liver transplant eligibility. Topics covered include the reference given to a paper which deals with inadequate referral to transplant for end-stage liver disease patients with an alcohol use history and the story related by surgeon Richard B. Freeman which sought to determine which patients with kidney disease should receive dialysis.

This article discusses findings of the study "A Systematic Review of the Relationship Between Staff Perceptions of Organizational Readiness to Change and the Process of Innovation Adoption in Substance Misuse Treatment Programs." Topics covered include the research papers on "organizational readiness to change" reviewed by researchers, a model for outlining the measures for organizational readiness for change, and how treatment programs can embrace innovations -- new evidence-based practices.

The article presents information on extended-release naltrexone which is also known as Vivitrol for the treatment of opioid use disorders (OUDs). Topics include concern regarding a paper by Alex Harris, M.D. titled "Specifying and Pilot Testing Quality Measures for the American Society of Addiction Medicine's Standards of Care," the ability of Vivitrol to prevent relapse, and the ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

A deeply researched white paper shows how mutual support groups can assist — and have assisted — people trying to deal with their drug use. The paper summarizes research on the use of these support groups and details how Narcotics Anonymous (NA) helps drug users, in much the same way Alcoholics Anonymous helps alcohol users, but there are some important distinctions. [ABSTRACT FROM AUTHOR]

The article discusses a white paper issued by Beacon Health Options "Confronting the Crisis of Opioid Addication" calling for a focus on outpatient medication-assisted treatment by primary care. Topics discussed include its focus on the need to treat opioid addiction as chronic condition, its criticism of providers of detox who did not participate in the continuum of care needed for chronic conditions and its support for 10 levels of care of the American Society of Addiction Medicine (ASAM).

A new payment model for addiction and recovery services was released last week in the form of a white paper called “Incentivizing Recovery.” The model, which is based on bundling — multiple providers get paid from the same fee — and capitation — the fee is preset, as in managed care – was proposed by Leavitt Partners, Facing Addiction with NCADD and Remedy Partners. [ABSTRACT FROM AUTHOR]

Sen. Kamala Harris (D‐California) is Democrat presidential candidate Joe Biden's pick for vice president. And although she has been pilloried by the pro‐marijuana progressives for her prosecution of marijuana cases, in fact, she was not overly aggressive in these cases, according to an article in The Mercury News. "There is no way anyone could say that she was draconian in her pursuit of marijuana cases," said Niki Solis, a high‐ranking attorney in the San Francisco Public Defender's Office during Harris' time as district attorney, the paper stated. Marijuana legalization was a centerpiece of her presidential campaign. For the Mercury News story, see https://www.mercurynews.com/2019/09/11/kamala‐harris‐prosecuting‐marijuana‐cases/. [ABSTRACT FROM AUTHOR]

The article discussed how a paper released by the federal Centers for Disease Control and Prevention (CDC) entitled "Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009-2011" accidentally promoted heavy drinking and misconstrued diagnostic criteria for alcohol dependence. It mentions that mass media widely circulated the paper, using the familiar synonym "alcoholics" instead of "alcohol dependence" that added to denial.

We recommend "Rethinking the 'Drug Dealer,'" a paper that came out last month from the Drug Policy Alliance. We hope it didn't get lost in your holiday email, but if it did, we're reminding you about it here. Who is a drug dealer, really? It's often the same person who is a patient. Someone who doesn't belong in jail. It's an enlightening and informative resource with stories about real people, as well as facts and figures. And it's an easy read. For the full text, go to http://www.drugpolicy.org/sites/default/files/dpa‐rethinking‐the‐drug‐dealer_0.pdf. [ABSTRACT FROM AUTHOR]

Jennifer L. Doleac and Anita Mukherjee are at it again. After last spring's publication of their working paper suggesting that providing naloxone, an overdose‐reversal drug, would just encourage more people to use fentanyl, they were roundly criticized by the public health research community (see ADAW, March 19). They said naloxone eliminated the "moral hazard" of opioid use. Both economists, they recently wrote a similar article published by the Brookings Institution, also suggesting that harm reduction in general, including syringe exchanges, promotes drug use and therefore contributes to overdoses. [ABSTRACT FROM AUTHOR]

The article discusses Recovery Brands and Elements' white paper on Internet marketing which was presented during the annual meeting of the National Association of Addiction Treatment Providers (NAATP). Topic discussed include claims that Recovery Brands' website does not allow advertisers to promise cures, its promise to fully disclose site ownership and sponsorships and examples of unethical digital marketing practices such as the use of only one phone number by a low-quality directory site.