News
The ASAM Weekly for September 10th, 2024
This Week in the ASAM Weekly
September is National Recovery Month, and according to SAMHSA, who ever had a substance use problem consider themselves to be recovering or in recovery. Provisional 2022 data from CDC, released early this year, suggests a in drug overdose deaths from the prior year, which would be the first annual decrease since 2018.
In honor of National Recovery Month and for all that goes into treating addiction and supporting recovery, we’d like to share with our readers some valuable resources about recovery.
91视频 Clinical Algorithm Subcommittee
As a part of ASAM’s mission to define and promote evidence-based best practices in addiction prevention, treatment, remission, and recovery, the 91视频 Clinical Algorithm Subcommittee will collaborate with ASAM staff in refining the 4th Edition clinical algorithms for 91视频 Criteria-based assessment tools. Applications are due by September 30th.
Lead Story
The American Journal on Addictions
National trends reveal a concerning escalation in racial and ethnic disparities in buprenorphine treatment duration for opioid use disorder. This study examined such disparities at the state level. Analyzing 9,040,620 buprenorphine prescriptions dispensed between January 2011 and December 2020 from IQVIA Longitudinal Prescription data, the study revealed substantial statewide variations in racial and ethnic disparities. Specifically, 21 states showed longer treatment durations for White people across all episodes, and 8 states displayed similar trends among episodes lasting ≥180 days. Longer treatment durations for White people in both overall and long-term episodes were exhibited in 5 states, and 15 states showed no racial and ethnic disparities.
Research and Science
Journal of Addiction Medicine
The authors reference their previous work showing that, at the same dose, plasma levels of buprenorphine were lower in pregnant patients. They have also observed that pregnant patients often choose to divide their daily dose into smaller, more frequent doses. For this study, the authors measured plasma buprenorphine concentrations at multiple points during the dosing interval in 22 pregnant patients. The providers chose the total daily dose, and patients chose the dosing interval. Plasma buprenorphine was 29% lower during pregnancy than the postpartum period and lowest (45% lower) during the second half of pregnancy. Patients chose dosing intervals that corresponded to the return of plasma concentrations to the baselines, and suppression of craving and withdrawal. The authors conclude that pregnant patients require higher buprenorphine doses and benefit from more frequent dosing intervals.
The Lancet Public Health
Mortality, suicide, self-harm, and substance use are elevated among people who are incarcerated. This systematic review and meta-analysis examined the effect of interventions delivered to people who use drugs during incarceration or after release from incarceration, on a wide range of outcomes. Receiving opioid-agonist treatment (OAT) in prison reduced the risk of death in prison, whereas receiving OAT in the first 4 weeks following release reduced risk of death in the community. Therapeutic community interventions reduced rearrest at 6–12 months and reincarceration at 24 months. There was scarce evidence that OAT and syringe service provision are effective in reducing injecting risk behaviors and needle and syringe sharing.
Journal of Addiction Medicine
This study examined the effect of various patterns of prenatal opioid exposure with birth outcomes. There were 138,123 Medicaid-covered pregnancies in Wisconsin between 2011 and 2019, and 20% had prenatal prescription opioid exposure. The 5 patterns of exposure and odds ratio for neonatal opioid withdrawal syndrome (NOWS) were stable MOUD (OR=22), inconsistent MOUD (OR=15), chronic analgesic opioid use (OR=19), intermittent analgesic opioid use (OR=6), and low level opioid use (OR=2). The majority of patients (78%) fit into the low level opioid use pattern. Although stable MOUD had a higher risk of NOWS than inconsistent MOUD, stable MOUD had greater birth weight (54 grams) and longer gestation (0.2 weeks).
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Morbidity and Mortality Weekly Report
Persons with non-substance-related mental health disorder (MHD) are at increased risk for nonfatal and fatal overdoses. This study found that, in 2022, 21.9% of persons with fatal overdoses had an MHD. Those who overdosed with an MHD were more likely to be female, non-Hispanic White, and have a history of known opioid use or misuse. Overall, 82.2 % of overdose deaths involved opioids, but among those with an MHD, a greater proportion involved antidepressants (9.7% vs 3.3%), benzodiazepines (15.3% vs 8.5%), and prescription opioids (16% vs 11.6%). In addition, 24.5% of those with an MHD had at least one interaction with potential for intervention within the month prior to overdose. These findings reinforce the need for screening for MHDs and substance use disorders (SUDs) and linkage to and integration of treatment for MHDs and SUDs.
International Journal of Environmental Research and Public Health
US young adults (age 21-29) have the highest prevalence of past-month tobacco, alcohol, and illicit drug use, and while marriage and having children have been associated with reduced risk of substance use, recent generations of young adults are reaching these milestones at later ages than previous generations. Given these changes, the study examined household composition among young adults and associations with substance use and found that those living with their children and spouse/partner had the lowest rates of substance use, while those living only with unrelated other individuals had the highest rates of use. The authors suggest that evidence-based substance use prevention and intervention strategies focused at the household level and accounting for shifting household composition may be indicated.
In The News
POLITICO
US Food & Drug Administration (FDA)
Tribune News Service/Hartford Courant
The Associated Press (AP)
MedPage Today
Forbes