Search

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]

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]

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]

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]

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.

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 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 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.