Fatal Opioid Overdoses by Historical and Contemporary Neighborhood-Level Structural Racism🔓

JAMA Health Forum 

This cross-sectional study of 796 census tracts prior to the COVID-19 pandemic (2017-2019) and 792 census tracts during the COVID-19 pandemic (2020-2022) in Chicago, Illinois, assessed the extent to which there is a spatial association between neighborhood-level structural racism and opioid-involved overdose deaths. Researchers found that neighborhoods exposed to high levels of structural racism in the past (historical redlining) and present (contemporary segregation) had the highest fatal overdose incidence rates before the COVID-19 pandemic (2017-2019). Neighborhoods that experienced high levels of contemporary racism had the highest fatal overdose incidence rates during the pandemic (2020-2022). 

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State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015–23

Health Affairs

While medications for opioid use disorder (MOUD) is effective treatment, most patients with OUD don’t receive it and prior authorization (PA) has been a barrier to access. Researchers looked at state policies trying to address this barrier, specifically for private health insurance, between 2015 and 2022. Some states adopted “full prohibitions” against PAs while others adopted “partial prohibitions” that allowed PA under some circumstances. Overall, the number of states with at least some prohibition increased from 2 in 2015 to 22 in 2023. In addition, 7 states adopted “full prohibitions” initially, while 15 adopted “partial prohibitions”, with 4 of those 15 transitioning to “full prohibitions” later. Additional research will be needed to assess the impact of these prohibitions, but this study elucidates the current landscape of policy.

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Rapid vs Standard Induction to Injectable Extended-Release Buprenorphine

JAMA Network

This industry-sponsored, multicenter, open-label randomized clinical trial with 729 participants, assessed if  rapid induction (RI) for initiating extended-release buprenorphine is as safe and effective as standard induction (SI) in individuals who inject opioids or use fentanyl.  RI was well tolerated and had higher retention than SI at extended-release buprenorphine injection 2 overall and in fentanyl positive participants. Administering the second extended-release buprenorphine injection 1 week after the first was well tolerated in both the RI arm and SI arm. These findings suggest support RI for extended-release buprenorphine induction in high-risk patients and demonstrate the feasibility of administering the first 2 doses at least 1 week apart.

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States With Substantial Increases In Buprenorphine Uptake Did So With Increased Medicaid Prescribing, 2018–24

Health Affairs

Multiple federal policy changes since 2018 intended to increase buprenorphine prescribing in response to a persistent treatment gap for opioid use disorder (OUD) in the US. Anticipated national increases did not occur, but highly variable state-level trends provide important insights. This study used IQVIA data to examine all-payer and per payer prescribing across states during the period 2018–24.  Researchers found that highly disparate state-level changes suggest that federal policy impacts were mediated by state-specific factors. Medicaid’s key role in driving overall prescribing highlights the public health urgency of maintaining expansions and sustaining enrollment for the single adult population. 

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Ultra-processed food addiction in a nationally representative sample of older adults in the USA 

Addiction

Using a cross-sectional online and telephone survey of a nationally representative sample of older adults (aged 50–80 years) in the US, this study examined the prevalence of ultra-processed food addiction (UPFA) in older US adults and its association with various health domains.  It found that ultra-processed food addiction appears to be prevalent among older adults in the US, particularly among women who were in adolescence and early adulthood when the nutrient quality of the US food supply worsened. Addictive patterns of UPF intake appear to be associated with poorer physical health, mental health, and social well-being.

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Alcohol Consumption Per Capita and Suicide: A Meta-Analysis

JAMA Network Open 

This meta-analysis that included 13 studies assessed if alcohol consumption per capita is associated with suicide mortality and, if so, does the association differ by sex. Researchers found that a 1-L increase in alcohol consumption per capita was associated with a 3.59% increase in the suicide mortality rate. There was no evidence of a sex difference in this association. These findings suggest alcohol consumption per capita may be a useful target to consider within comprehensive national suicide prevention strategies. 

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Measures of General Intelligence and Risk for Alcohol Use Disorder

JAMA Psychiatry

This male Swedish cohort study that included 573,855 participants assessed if there is an association between IQ and risk for alcohol use disorder, and if so, what is the nature of this association.  It found that IQ at age 18 years was associated with subsequent alcohol use disorder risk. Mendelian randomization analyses suggest a causal association, albeit with context-dependent differences; genetic liability for cognitive performance also predicted alcohol use disorder in a US-based sample. Results suggest that there was a clear impact of genetic liability for cognitive performance on alcohol disorder risk, but the association varies based on the sociocultural context.

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Medications for Opioid Use Disorder Playbook

Agency for Healthcare Research and Quality (AHRQ) 

The AHRQ Integration Academy developed the Medications for Opioid Use Disorder Playbook as a practical guide for providing medications for opioid use disorder (MOUD) and immediate care for patients with OUD in primary care and other ambulatory care settings. It is interactive, web-based, and has the latest guidance, tools, resources, and examples that address key aspects of MOUD implementation. The MOUD Quick Start Guide covers the essentials of low-threshold care, while the balance of the Playbook offers more in-depth resources and guidance for those practices interested in working toward more comprehensive, whole-person care. The low-threshold approach ensures immediate access to MOUD, eliminating barriers for both patients and providers. 

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Environmental, Psychiatric, and Genetic Predictors of Alcohol Use Disorder Criterion Count: Analyses of African and European Ancestries

The American Journal of Psychiatry

Quantifying the contribution of environmental and genetic factors to alcohol use disorder (AUD) criterion count across different ancestries may provide insight into the biopsychosocial etiology of AUD. Although polygenic risk prediction represents an important future application, its utility may be enhanced when considered in the context of environmental predictors. The authors used large African- and European-ancestry samples to examine how genetic, psychiatric, and environmental factors predict AUD criterion count.  In both African and European ancestry groups, environmental factors explained the majority of the variance in AUD criterion count, but polygenic risk was also a statistically significant predictor. These findings may help inform clinical, research, and policy efforts to mitigate AUD risk.

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Cannabis Use During Pregnancy and Lactation

American College of Obstetricians & Gynecologists

Cannabis is the most commonly used illicit drug under U.S. federal law. With increasing social acceptability, accessibility, and legalization in many states, the prevalence of cannabis use among pregnant and lactating individuals has increased significantly. Substance use in pregnancy, including cannabis use, has been associated with adverse outcomes such as spontaneous preterm birth, low birth weight, and developmental delay. Clinicians should be aware of the possibility of pregnant and lactating patients' use of cannabis and be prepared to counsel and screen all patients and use evidence-based strategies to reduce cannabis use.  These include supportive home visits, psycho-behavioral strategies, or brief electronic or text messaging interventions to reduce cannabis use in pregnancy and the postpartum period to promote parental and newborn health.

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