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This Week in the ASAM Weekly

We have a mantra at the ASAM Weekly—“52 weeks-a-year”—and for the last year and a half, the 3 ASAM Weekly co-editors have been pulling their weight plus one to keep this publication going. It’s a rewarding role but an unrelenting schedule (at times) to search, evaluate, and summarize the latest research in addiction medicine. They do all of this while putting up with the (occasionally) idiosyncratic decisions of their editor in chief (like the one about capping the number of JAMA articles in a week because too much JAMA is a thing).

Behind the scenes, there is a great e-mail camaraderie that has helped shape the publication as much as it helps bond the editorial team. In a small way, it’s motivation to be a part of this.

But as with any volunteer position, there is an intangible balance that must be maintained to keep the volunteers motivated. For the ASAM Weekly, that balance is to have four co-editors, and now we do (again).

(Drumroll please)

The editorial team would like to introduce our newest co-editor:

Sarah Messmer is an assistant professor at the University of Illinois Chicago (UIC) and is board certified in internal medicine, pediatrics, and addiction medicine. She is the clinical lead of the UIC Community Outreach Intervention Projects Mobile Medications for Opioid Use Disorder program, which provides low-barrier substance use treatment and primary care via mobile units in Chicago neighborhoods with high overdose rates. As a physician-scientist, she has a particular focus on implementation science and in developing community-based programs that deliver evidence-based addiction treatment and meet people where they are.

In her spare time, Sarah enjoys exploring the outdoors, reading, going on adventures with her kids, and hanging out with her 2 dogs, 2 cats, and (best of all) 2 chickens.

Welcome to the team, Sarah! Thank you for restoring balance to the ASAM Weekly and averting a potential strike from your 3 fellow co-editors. 

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

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

Lead Story

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PLOS Mental Health

The opioid epidemic unfolded in 3 distinct waves, with the latest being deaths attributed to illegally manufactured synthetic opioids. Using US and Canadian data, researchers reviewed evidence for a 'silent epidemic,' alongside the opioid epidemic, that is characterized by the co-ingestion of stimulants including methamphetamine and cocaine leading to an increasing number of deaths. Trends for stimulant and opioid use were analyzed using Joinpoint regression, and public interest in the substances was assessed via Google Trends. While stimulant use and its role in deaths are rising, public interest in stimulants has declined since its peak in 2004-05. Co-use of opioids and stimulants leads to more deaths than use of either drug alone. Urgent strategies are needed to reduce harm and raise awareness among health professionals, policymakers, and the public about the dangers of stimulant-opioid co-use.

Research and Science

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Addiction

This study based in England looked at the number of deaths attributable to tobacco smoking versus illegal drugs among a cohort of people who use heroin. The study included 106,789 patients between 2001 and 2018 and found that the all-cause mortality rate in this population was 7.72 times higher than in the general population. In this cohort, tobacco use accounted for approximately 25% of premature deaths, about equal to the number of premature deaths attributed to illegal drugs. The article highlights the need to focus on reducing harm from tobacco use—not only opioid use—for this patient population. Further research is needed to guide smoking cessation efforts for this population.

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Harm Reduction Journal

Many surveys of people who inject drugs (PWID) often underrepresent people of color, those living in rural areas, and those with housing instability. In this paper, researchers describe methodology used to create a nationally representative cohort sample using online recruitment with a goal of assessing a mail-based harm reduction service. The authors worked with a community advisory board to develop the study and recruited participants in 3 phases: 1) online forums explicitly for people who use drugs (PWUD)/low recruitment, 2) mainstream websites with greater reach but targeted PWUD/high recruitment, and 3) popular social media with limited targeting of PWUD/high recruitment. Various methods were used to block non-US participants and bots. In addition, the authors used specific knowledge questions to ensure participants were PWID.

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JAMA Network Open

Although women make up the majority (68%) of people with comorbid PTSD and alcohol use disorder (AUD), they are underrepresented in treatment research. In this study, 90 women were randomly assigned to receive integrated treatment (exposure therapy for PTSD, relapse prevention for AUD) or relapse prevention only. Weekly sessions were delivered for 12 weeks with follow-up to 36 weeks. PTSD symptom severity decreased in both groups, with a drop from 37 to 13 in the integrated treatment group and 39 to 24 in the relapse prevention group. The decrease in the integrated treatment group was statistically significantly greater than for relapse prevention alone. Self-reported alcohol use decreased following treatment in both groups with no difference between treatment groups. Integrated treatment was more effective in reducing PTSD symptoms than AUD treatment alone, but both treatments had similar effects on alcohol use.

Learn More

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JAMA Health Forum

This is a viewpoint article emphasizing the rise in accidental THC ingestions by children, particularly under age 6, driven by marijuana edibles in the form of candy, gummy bears, or brownies. As legal marijuana becomes more accessible across the country, the authors call for public health initiatives to prevent easy access to edibles and accidental ingestion by children, specifically through standardized regulations for packaging and distribution of edible cannabis products. The authors call for decreasing the recognizability of the labels and childproofing of edible marijuana packages, similar to Canadian regulations, as well as avoiding multiple-dose packaging.

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Journal of Behavioral Addictions

Inducements are a core component of gambling marketing. They have attracted increased attention from regulators due to their potential links to gambling harms. Researchers deployed a randomized, pre-registered online experiment to test whether inducements cause specific changes to gambling behavior. In this study, 622 males under the age of 40 made incentive-compatible betting choices over Euro 2024 football matches. Participants were randomized to see bets with inducements or to a control group with no inducements. Some participants were also randomized to see inducement-linked bets where the expected value odds made them the worst available choice, ie, a dominated option that was an objectively “bad bet” even accounting for the inducement. Inducements increased the amount spent on bets by over 10% and almost halved the number of people opting not to bet. Those with evidence of problem gambling were disproportionately affected. Inducements also led to decision errors, making bettors three times more likely to choose bad bets.

Journal of Psychopharmacology

Gamma-aminobutyric acid – A (GABA-A) receptors are thought to mediate the subjective effects from alcohol intoxication and be a potential target to reverse intoxication. In this randomized, double-blind placebo study researchers evaluated iomazenil, a benzodiazepine inverse agonist, to assess if it could mitigate some of the effects of ethanol intoxication. Thirty-three healthy volunteer males were given IV ethanol or placebo and IV iomazenil or placebo and evaluated for stimulant and sedative effects of alcohol. Receipt of IV ethanol was associated with sedation and stimulant effects, and iomazenil was associated with increase in anxiety; however, iomazenil was not associated with reduction in ethanol effects.

Journal of Addiction Medicine

This commentary is written by a medical student with prior experience working in an opioid treatment center. Substance use (SU) is prevalent among medical students with 18% reporting prescription stimulant use and one-third meeting criteria for alcohol use disorder. Also, depression and generalized anxiety among medical students is 5-8 times higher than among their peers. Negative attitudes towards mental health and SU are common among medical professionals inducing shame and stigma in affected students. The AAMC has issued 6 guidelines for addressing student SU; however, in 2021 50% of schools met none of the guidelines and only one met all 6. First-year orientation at this student’s school incorporates a session on harm reduction including using fentanyl and xylazine test strips and sterile injection technique. Many schools engage in efforts to address student burnout and suicide that should also include student SU and harm reduction.

In the News

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New England Public Media

The New York Times

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MarketWatch

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STAT

National Geographic

STAT

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National Public Radio (NPR)