Postoperative Restrictive Opioid Protocols and Durable Changes in Opioid Prescribing and Chronic Opioid Use

JAMA Oncology

This prospective cohort study investigated whether postsurgical acute pain using a restrictive opioid prescription protocol (ROPP) of 3 days or less after discharge would result in reduced opioid use. Mean opioid prescribing days decreased from a mean (SD) of 3.9 (4.5) days in the pre-ROPP group to 1.9 (3.6) days in the post-ROPP group (P

A neuromarker for drug and food craving distinguishes drug users from non-users

Nature Neuroscience

Functional MRI images were obtained while subjects were exposed to visual cues for drugs and palatable foods and asked to rate their level of craving. Subjects were individuals who use drugs (cigarette users=21, alcohol users=17, and cocaine users n=21) and matched controls (n=40). Machine learning was used to identify a pattern of neural activation associated with craving, the Neurobiological Craving Signature (NCS), that extended throughout the brain including areas such as the parietal and temporal areas and cerebellum, not usually associated with craving. The same NCS was found for food and drugs indicating the similarity of these cravings. NCS response to drug cues was able to identify individuals who use drugs with an 82% accuracy. The authors suggest that the NCS has promise for diagnosing SUD as well as measuring responses to treatment.

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The ASAM Weekly's most read news items from 2022 were as follows:

On ‘Last Week Tonight,’ John Oliver Takes on the Nation’s Dumbest Drug Myth

Rolling Stone

High-dose drug treats fentanyl overdose, if you can get it

New Haven Register

A man who lost 80 pounds on a 'game changer' weight-loss drug also lost his desire to drink alcohol. Experts say the drug could be a treatment for addiction. 

MSN/Insider 

The Next Big Addiction Treatment

The New York Times 

What Is Delta-8, and Why Is It So Popular?

The New York Times 

Can a monthly injection be the key to curbing addiction? These experts say yes

Los Angeles Times 

They Call It ‘Tranq’ — And It’s Making Street Drugs Even More Dangerous

KHN 

Medication for Drinking Addiction May Thwart Liver Disease 

MedPage Today 

The Most Important Question About Addiction

The New York Times 

Gabapentin's link to fatal drug overdoses draws concern

UPI News  

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Defining Recovery From Alcohol Use Disorder: Development of an NIAAA Research Definition

The American Journal of Psychiatry

The authors present a newly developed National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of recovery from the DSM-5 diagnosis of alcohol use disorder (AUD). This definition views recovery as a process of behavioral change and an outcome, incorporating two key components of recovery: remission from DSM-5 AUD and cessation from heavy drinking, a non-abstinent recovery outcome. It also emphasizes the importance of biopsychosocial functioning and quality of life in enhancing outcomes. By adopting a uniform definition, researchers and health care professionals can more precisely operationalize and measure recovery-related processes.

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Genetic diversity fuels gene discovery for tobacco and alcohol use 

Nature

This study leverages global genetic diversity across 3.4 million individuals from four major clines of global ancestry to power the discovery and fine-mapping of genomic loci associated with tobacco and alcohol use, to inform function of these loci via ancestry-aware transcriptome-wide association studies, and to evaluate the genetic architecture and predictive power of polygenic risk within and across populations. The authors found that increases in sample size and genetic diversity improved locus identification and fine-mapping resolution, and that a large majority of the associated variants showed consistent effect sizes across ancestry dimensions. However, polygenic risk scores developed in one ancestry performed poorly in others, highlighting the continued need to increase sample sizes of diverse ancestries to realize any potential benefit of polygenic prediction.

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Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy 

The New England Journal of Medicine

This cohort study involving pregnant persons in the US from 2000-2018 found that buprenorphine treatment for opioid use disorder during pregnancy was associated with more favorable neonatal outcomes than methadone treatment. Neonatal abstinence syndrome occurred in 69% of the infants exposed to methadone as compared with 52% of those exposed to buprenorphine in the 30 days before delivery. An inverse association was also observed between buprenorphine exposure (as compared with methadone exposure) and preterm birth, regardless of whether exposure occurred in early or late pregnancy in both the unadjusted and adjusted analyses. Inverse associations were also observed between buprenorphine exposure (as compared with methadone exposure) and small size for gestational age and low birth weight.

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Increased vulnerability to atrial and ventricular arrhythmias caused by different types of inhaled tobacco or marijuana products 

Heart Rhythm

This study investigated the cardiovascular effects of exposure to tobacco smoke, vape aerosol, heated tobacco products, marijuana smoke, THC free marijuana, or air (placebo control). Rats were exposed to a single 5 minute session 5 days a week for 2 months. This exposure was judged to be similar to a single smoking or vaping session a day. Left ventricular dilation and reduction in LV ejection fraction was seen in all non-air groups along with reduction in heart rate variability. Both atrial fibrillation and ventricular tachycardia were more easily induced in all non-air groups. Decrease in microvessel density and severe interstitial fibrosis was seen on histology from all non-air groups. The authors conclude that all tobacco products (including vaping) and marijuana carry substantial risk of cardiac disease.

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Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study 

BMC Public Health

The authors note a dramatic increase in the use of methamphetamine in people with OUD and an increased presence of a stimulant in opioid toxicity deaths. A random sample of 20% of persons in the overdose registry of the Province of British Columbia, Canada, was selected for years 2010 to 2018. Persons who used opioids, stimulants, or both (n=7460) were identified by ICD codes and fatal overdose events determined from coroners’ data. People using both opioids and stimulants had twice the risk of fatal overdose compared to those using opioids only (HR=2.02, p

Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression

NEJM

Results of a phase II trial testing the psychedelic compound in magic mushrooms as a treatment for depression have found that the drug psilocybin is effective, but not to the extent that earlier, smaller studies had suggested. The proportion of participants in remission after treatment dropped over time, raising questions about its durability and whether additional doses would be helpful. Among adults with treatment-resistant depression, a single dose of 25 mg of psilocybin, but not 10 mg, reduced depression severity significantly more than a 1-mg dose at 3 weeks. The trial did not compare psilocybin with existing treatments for depression and persons who were judged to be at a clinically significant risk for suicide were excluded from the trial.

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Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019 

JAMA Network Open 

This cross-sectional study sought to estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults 20 to 64 years of age. Alcohol-attributable deaths accounted for an estimated 20.3% of total deaths among adults 20 to 49 years of age. By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to a high of 21.7% in New Mexico. Findings suggest that alcohol-attributable deaths were responsible for 1 in 8 deaths among adults 20 to 64 years of age, and 1 in 5 deaths among adults 20 to 49 years of age. The authors suggest that these death rates could be reduced with increased implementation of evidence-based policies, such as increasing alcohol taxes or regulating alcohol outlet density.

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