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This Week in the ASAM Weekly

A news release from the National Institute on Drug Abuse highlights some important findings from the latest Monitoring the Future (MTF) survey (). Young and mid-life adults continue to use cannabis and hallucinogens at historically high levels, while tobacco use remains low. But the generations differ regarding vaping and binge drinking which tend to occur most often in young and mid-life adults, respectively. 

A notable example of this is the significant reductions in alcohol use among young adults in Ireland. Although a recent  article acknowledges increasing health-literacy around alcohol use, it seems to reflect more excitement around the increasing market share of non-alcoholic drinks.

There is something to be said then about how the market influences substance use behavior. The DEA has effectively delayed the decision about reclassifying cannabis until after the election, and the cannabis industry is not happy (). But if we consider data from MTF, it’s hard not to see a temporal relationship between cannabis use and legalization. 

Even geo-political macrotrends, such as supply chains and shipping routes, play a significant role in substance use. The US government is courting Pacific nations to counter the undue influence Chinese firms have in the US opioid and methamphetamine crises (). 

In that regard, public health officials in San Francisco are responding to the methamphetamine crisis with a mix of pharmacology and marketing. Rather than using a pragmatic name like “Packages of Olanzapine,” they’ve opted for the more clever “chill packs” which help mitigate some of the adverse effects of methamphetamine use, like psychosis and emergency service utilization, in high-risk populations (). 

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM, Jack Woodside, MD, John A. Fromson, MD

Lead Story 

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Annals of Medicine

Mindfulness-Oriented Recovery Enhancement (MORE) uses mindfulness training to address dysregulation in brain reward systems. MORE has been shown to reduce drug cue reactivity and in an RCT reduced opioid misuse 45% at 9 months. Face-to-face MORE requires significant time of trained clinicians, and this study explored the feasibility of delivering MORE by virtual reality (VR). Treatment consisted of 8 weekly, one-hour MORE-VR sessions. Patients could choose the VR setting for their meditation (beach, forest, waterfall) and interact with virtual drugs and paraphernalia during session 5, which was devoted to examining and managing craving. Of 38 patients, 68% completed 4 or more sessions and 50% completed all sessions. Opioid use decreased significantly (p =.04), as well as craving (p<.001), and results showed a significant increase in positive affect (p<.001).

Journal of Substance Use and Addiction Treatment

This study examined availability of opioid agonist treatment (OAT) in residential SUD treatment facilities in North Carolina. Researchers identified 94 residential treatment facilities in the state and were able to collect data on 66. Data were obtained from websites and calls made by research staff posing as prospective patients. OAT was provided on site by 11% of facilities, 14% allow OAT from an outside provider, and the rest barred the use of OAT. Callers to half of the facilities received negative comments about OAT, such as statements like “trading one addiction for another.” OAT availability was associated with facilities holding a state license (p=0.002) and offering 12-step programs (p=0.02). OAT availability was negatively associated with facilities incorporating faith-based programs (p=0.001). The authors conclude that “stigma against OAT remains pervasive.”

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Journal of Substance Use and Addiction Treatment

This study examined availability of opioid agonist treatment (OAT) in residential SUD treatment facilities in North Carolina. Researchers identified 94 residential treatment facilities in the state and were able to collect data on 66. Data were obtained from websites and calls made by research staff posing as prospective patients. OAT was provided on site by 11% of facilities, 14% allow OAT from an outside provider, and the rest barred the use of OAT. Callers to half of the facilities received negative comments about OAT, such as statements like “trading one addiction for another.” OAT availability was associated with facilities holding a state license (p=0.002) and offering 12-step programs (p=0.02). OAT availability was negatively associated with facilities incorporating faith-based programs (p=0.001). The authors conclude that “stigma against OAT remains pervasive.”

Learn More 

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Alcohol, Clinical and Experimental Research

This paper reviews research that identifies empirically supported mediators of alcohol and other drug use and related outcomes and then evaluates their potential as being alcohol and other drug (AOD) treatment mechanisms of behavioral change (MOBC). The implementation of self-efficacy, social support, and craving into clinical practice and training is warranted. The authors present six directions for future research to solidify and generalize empirical support for the case that self-efficacy, social support, and craving are MOBC; they also offer five implications for clinical practice and training.

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BMJ

This systematic review and Bayesian network meta-analysis evaluated the comparative effectiveness and acceptability of oral monotherapy using psychedelics and escitalopram in patients with depressive symptoms, considering the potential for overestimated effectiveness due to unsuccessful blinding. Placebo response in psychedelic trials was lower than that in antidepression trials of escitalopram. Of the available psychedelic treatments for depressive symptoms, patients treated with high dose psilocybin showed better responses than those treated with placebo in the antidepressant trials, but the effect size was small.

JAMA Internal Medicine

Since 2023, all clinicians with a DEA license can prescribe buprenorphine for opioid use disorder, although this practice is still uncommon outside of addiction treatment specialists. In this article, the authors provide a short overview of buprenorphine, its formulations, and its use in treatment to provide non-addiction clinicians with knowledge to initiate and continue buprenorphine treatment. The article provides direction for traditional initiation approaches and micro-dosing, as well as reference to guidance for precipitated withdrawal. In addition, it provides guidance for dosing based on a patient's substance use history, including high-potency synthetic opioids (unregulated fentanyl). 

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Scientific Reports

Anabolic-androgenic steroids (AAS) are known to be associated with adverse cardiovascular events, but the effect on vascular function is less clear. In this study, researchers examined carotid artery reactivity (CAR%) and flow-mediated dilation (FMD), both markers of endothelium function, in men with >1 year AAS use versus men with no history of AAS use. Men with AAS use had significantly lower CAR% (3.58 vs 6.33, p<0.001) and lower FMD response (3.99% vs 6.72%, p<0.001). These findings are similar to patterns in other groups at increased risk of cardiovascular disease and shed light on the increased risk of myocardial infarction and sudden cardiovascular death observed in young men who use AAS.

In The News 

National Institute of Drug Abuse (NIDA)

San Francisco Chronicle 

The Philadelphia Inquirer 

Medical College of Wisconsin 

British Broadcasting Corporation (BBC) 

Forbes

Reuters