The impact of schizophrenia genetic load and heavy cannabis use on the risk of psychotic disorder in the EU-GEI case-control and UK Biobank studies

Psychological Medicine

Using data from the EU-GEI case-control study and UK Biobank, researchers examined the independent and combined effect of heavy cannabis use and schizophrenia polygenic risk score (PRS), on risk for psychosis. Schizophrenia PRS and cannabis use independently increased risk of psychosis. Schizophrenia PRS was not associated with patterns of cannabis use. It was associated with lifetime and daily cannabis use without psychosis, but the effect was substantially reduced when cannabis use disorder (CUD) PRS was included in the model. Regular users of high-potency cannabis had the highest odds of being a case independently of schizophrenia PRS. Regular use of high-potency cannabis remains a strong predictor of psychotic disorder, independent of schizophrenia PRS. Schizophrenia PRS does not seem to be associated with heavy cannabis use. These are important findings, at a time of increasing use and potency of cannabis worldwide. 

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Prevalence of pharmacotherapy for attention-deficit/hyperactivity disorder and prescription stimulant misuse: A national study of US college students

Addiction

This is an observational study using cross-sectional data from the American College Health Association–National College Health Assessment III. It measured the association between university-level prevalence of attention deficit/hyperactivity disorder (ADHD) medication treatment and prevalence of prescription stimulant misuse (PSM) among college students.  Among university students in the United States, there appears to be a positive association between attending universities with a greater prevalence of ADHD medication treatment and risk of prescription stimulant misuse (PSM). This study provides further support for the possibility that ADHD medication treatment prevalence is a risk factor for PSM.

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Xylazine Pharmacokinetics in Patients Testing Positive for Fentanyl and Xylazine 

Clinical Chemistry

This study of xylazine pharmacokinetics used plasma samples from 28 patients who had urine screens positive for xylazine and fentanyl. The patients were being treated for skin lesions, most commonly, then shortness of breath or opioid overdose. At least two subsequent plasma samples were analyzed for xylazine and xylazine metabolites by LC-MS/MS. The median terminal half-life for xylazine in plasma was 12 hours (range 6-21 hours). Animal studies show xylazine to be extensively metabolized, with little unchanged xylazine eliminated in urine. The two most abundant metabolites were oxo-x and sulfone-x, which did not have a window of detection longer than xylazine. Researchers had no information as to the timing or route of xylazine ingestion or if additional xylazine was consumed during the study period. These factors could affect the accuracy of the results.

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Suicide in people prescribed opioid-agonist therapy in Scotland, United Kingdom, 2011–2020: A national retrospective cohort study 🔓

Addiction

This retrospective cohort study aimed to determine if opioid agonist therapy (OAT) in Scotland is protective against suicide, and measure trends in suicide rates in those with opioid dependence over time. The study included 46,453 individuals who received at least one prescription for OAT between 2011 and 2020 with over 304,000 person-years (pys) of follow-up. Results suggested that people with opioid dependence in Scotland have a greater risk of suicide than the general population. Treatment is protective, with rates of suicide lower among those on opioid agonist therapy. Suicide rates have decreased over time, during a period in which drug-related death rates in Scotland have risen to globally high levels.

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Links between adolescent binge drinking and midlife alcohol use behaviors by age, sex, and race/ethnicity 🔓

Alcohol Clinical and Experimental Research

Using data from the Monitoring the Future study, which enrolled cohorts of high school seniors annually starting in 1976, this analysis evaluated alcohol drinking patterns in adults 35-60 and potential association with their drinking patterns at age 18. Overall, the reported mean number of drinks at a time ranged from 1.7 to 1.4, and the mean maximum number of drinks ranged from 3.2 to 2.3. The reported number of drinks was generally lower at older ages. Those who reported binge drinking at 18 versus those who did not report a significantly higher mean (2.3 vs. 1.3) and maximum (4.0 vs. 2.3) number of drinks as adults. Additionally, they were more likely to report binge drinking (39.5% vs 19.1%) and high-intensity drinking (10.5% vs 4.4%) as adults. Further, this association was even stronger in older age groups, suggesting adolescent binge drinking is a risk factor across the lifespan.

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Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder

JAMA Network

This population-based retrospective cohort study assessed whether the use of buprenorphine/naloxone is associated with lower risk of treatment discontinuation and mortality compared with methadone. It included 30,891 individuals initiating treatment for the first time during the study period and found that  the risk of treatment discontinuation was higher among recipients of buprenorphine/naloxone compared with methadone (88.8% vs 81.5% within 24 months). The risk of mortality was low while in either form of treatment (0.08% vs 0.13%).  Individuals receiving methadone had a lower risk of treatment discontinuation compared with those who received buprenorphine/naloxone. The risk of mortality while receiving treatment was similar between medications.

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Association of Daily Doses of Buprenorphine With Urgent Health Care Utilization 🔓

JAMA Network Open 

This cross-sectional study using health care claims data from 35,451 US adults with an opioid use disorder diagnosis assessed whether buprenorphine treatment using doses higher than Food and Drug Administration recommendations is associated with subsequent acute health care utilization. Those receiving higher maximum doses of buprenorphine (i.e., doses above 16 mg and 24 mg) had significantly lower rates of acute care utilization than their peers receiving FDA-recommended doses (between 8 mg and 16 mg). These results suggest that higher doses of buprenorphine are associated with lower acute care utilization and could provide benefits to patients, particularly those using fentanyl who might need these higher doses.

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Facilitators of and barriers to buprenorphine initiation in the emergency department: a scoping review 

The Lancet Regional Health Americas

In the context of the opioid overdose epidemic, great efforts have been made to increase access to medication for opioid use disorder (MOUD), specifically buprenorphine. Initiation of buprenorphine in emergency departments (ED) has been a focus of these efforts. While initiation has been increasing, only 3-15% of persons treated in EDs fill a prescription. In this summary literature review, authors examined potential barriers and facilitators to initiation. Having care-coordination with streamlined and easy connection to outpatient treatment was associated with increased initiation. Conversely, the absence of care-coordination was associated with decreased uptake. Additionally, provider training and comfort increased uptake as did flexibility in induction strategies. 

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Cannabis Policy Impacts Public Health and Health Equity

National Academy of Sciences Engineering Medicine

This report from the National Academies of Sciences, Engineering, and Medicine urges the federal government to provide policy guidance to states that have legalized cannabis, close regulatory loopholes on intoxicating products derived from hemp, and create a public health campaign aimed at parents and vulnerable populations, among other measures that would protect public health and reduce the harms of rising cannabis use. Federal action includes closing regulatory loopholes for hemp-derived cannabinoids, a cannabis public health campaign, best practices for cannabis policy, and improved cannabis public health data and allowing research. State action includes required training for cannabis retail staff, automatically expunging criminal records, a model for state cannabis policy, and setting product standards. 

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In this episode recorded live at ASAM's 55th Annual Conference in Fort Worth, TX, host Dr. Nick Athanasiou sat down with Dr. Shannon Miller to discuss his work on PAM-7, and his path to addiction medicine.

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