MASAM - Massachusetts Society of Addiction Medicine
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Waltham, MA 02451
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MASAM news
May 17, 2018
MASAM has been active in supporting inclusion of language in various state bills that would mandate evidence-based treatment of OUD for adults incarcerated in the Commonwealth. We include a letter from the Association for Behavioral Healthcare that nicely summarizes the issues. In which bill we ultimately succeed in promoting humane and effective care is not predictable currently.
Letter to HCF Chairs re MAT in CARE Act 5.15.18 (click here)
ASAM Weekly
Below you'll find the lead stories of ASAM Weekly. Click here If you want to subscribe,
2019
September 17, 2019
The Future of Fentanyl and Other Synthetic Opioids
Deaths involving synthetic opioids in the United States increased from roughly 3,000 in 2013 to more than 30,000 in 2018 and synthetic opioids are now involved in twice as many deaths as heroin. This book offers a systematic assessment of the past, present, and possible futures of synthetic opioids in the United States. The goal is to provide decision-makers, researchers, media outlets, and the public with information to better understand the synthetic opioid problem and how to respond to it.
September 10, 2019
Surgeon General Issues Advisory Warning Pregnant Women and Teenagers Not to Smoke or Vape Marijuana
On August 29 the U.S. Surgeon General, Dr. Jerome Adams, issued an advisory warning against marijuana usage by pregnant women and teens, noting that usage has been linked to deficits in attention and memory in teens, and lower birth weight in the children of pregnant women. The advisory closed by calling for more research, as well as science-based messaging campaigns and targeted prevention programming.
September 3, 2019
Acute Effects of Electronic Cigarette Aerosol Inhalation on Vascular Function Detected at Quantitative MRI
Studies have shown that electronic cigarettes containing nicotine cause vascular endothelial damage and alterations in vascular tone; however, the effect of the aerosol alone on endothelial function is not fully understood. This study utilized a multiparametric MRI protocol to quantify the effects of non-nicotine aerosol on peripheral vascular reactivity, cerebrovascular activity, and aortic pulse wave velocity in non-smokers before and after sixteen 3-second inhalations. The results indicate transient but notable macrovascular alterations, microvascular impairment, and a marginal increase in aortic stiffening. The study provides additional insight into the endothelial damage caused by electronic cigarette exhalants and warrants further study in larger cohorts.
August 27, 2019
Reports and Detailed Tables From the 2018 National Survey on Drug Use and Health (NSDUH)
SAMHSA released the latest data findings from the 2018 NSDUH which provides estimates of the use of illegal substances, prescription drugs, alcohol, and tobacco, as well as mental disorders, treatment, and co-occurring substance use and mental disorders in the United States. Some important findings include decreasing rates of prescription opioid misuse and heroin use disorder, decreased substance use during pregnancy, increasing rates of cannabis use, and increasing rates of suicidality in young adults. A recorded presentation by Dr. Elinore F. McCance-Katz is also available.
August, 20, 2019
Screen All Adult Patients for Drug Abuse, National Panel Urges
The U.S. Preventive Services Task Force is recommending that all primary care clinicians screen all adult patients for illicit drug use, including improper use of prescription medications. This is a major shift from their 2008 guidelines as the panel notes there is sufficient evidence now indicating that screening and appropriate referrals can lead to a reduction in substance use. The panel does acknowledge several challenges clinicians may face when implementing these guidelines and is accepting public input until September 9th.
August 13, 2019
Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women
Research has shown that opioid prescribing after major or minor procedures is associated with the onset of persistent opioid use. By reviewing insurance claims data on close to one million women, this study assessed the association between peripartum opioid prescribing for vaginal or cesarean delivery with rates of new persistent opioid use. The results suggested that opioid prescribing and persistent opioid use have decreased since 2008; however, the strongest modifiable factor associated with persistent opioid use after delivery was filling an opioid prescription before delivery.
JAMA >>>
August 6, 2019
Nabiximols for the Treatment of Cannabis Dependence
A prior feasibility study found that Nabixomols (cannabinoid agonist containing tetrahydrocannabinol and cannabidiol) when combined with therapy helps reduce cannabis use. This study evaluated the safety and efficacy of a twelve-week course of Nabixomols in individuals with cannabis dependence (N=128). The results indicate that Nabixomols in combination in psychosocial treatments reduced cannabis use by about 18 days (30% reduction); however, abstinence from illicit cannabis was achieved by only a minority of patients.
July 30, 2019
Summer as a Risk Factor for Drug Initiation
Using data from the National Surveys on Drug Use and Health (USA; 2011–2017), this study determined whether new initiates of cannabis, ecstasy, LSD, and/or cocaine first used their substance in the summer months. Although the risk for initiation for each drug examined was fairly consistent throughout the year, more than a third of LSD use and more than a quarter of cannabis, cocaine, and ecstasy use was initiated during the summer months. Prevention efforts may need to increase in the months leading up to summer.
Journal of General Internal Medicine>>>
July 23, 2019
Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
An important area of concern for SAMHSA is promoting policies and practices to lower the risk of overdose for persons with opioid use disorder (OUD) who are or have been in contact with criminal justice systems. This guide focuses on using medication-assisted treatment for opioid use disorder in jails and prisons and during the reentry process when justice-involved persons return to the community. It provides an overview of policies and evidence-based practices that reduce the risk of overdose and relapse.
July 16, 2019
Change in moderate alcohol consumption and quality of life
Global alcohol consumption is rising and is the leading risk factor for global burden of disease, however, the risks and benefits of moderate drinking are not clear. To better understand the effects of moderate drinking, this study surveyed the mental and physical well-being of more than 10,000 individuals in Hong Kong who were either nondrinkers or moderate drinkers and validated their findings with results from NESARC. Similar to studies in US populations, the results indicate higher mental well-being scores in lifetime abstainers but the most benefit was seen in women who quit alcohol use.
July 9, 2019
Characteristics of US Counties With High Opioid Overdose Mortality and Low Capacity to Deliver Medications for Opioid Use Disorder
In order to reduce opioid overdose deaths it is important to understand the geographic relationship between treatment availability and overdose death rates at the county level. This study compared rates of opioid overdose mortality from 3142 US counties with the availability of clinicians providing medications for opioid use disorder (MOUD) - buprenorphine, methadone or extended-release naltrexone. The results indicate 46.4% of all counties and 71.2% of rural counties still lacked MOUD providers and counties in the South Atlantic, Mountain, and East North Central divisions were particularly burdened. This data could better inform policymakers in developing interventions tailored toward challenges specific to a region.
July 2, 2019
Patterns of Opioid Administration Among Opioid-Naive Inpatients and Associations With Postdischarge Opioid Use
Initiatives to reduce or monitor high risk opioid prescribing have mostly focused on outpatient prescribing even though inpatient pain management has been implicated as a driver for increased opioid use. This study examined both inpatient and outpatient data in opioid-naive patients to understand associations between inpatient opioid administration and long-term opioid use. The results indicate that nearly half of opioid-naïve inpatients received opioid medications for pain and most received opioids before non-opioid analgesics. Inpatient opioid administration was also associated with about twice the probability of outpatient use, presenting an opportunity for hospital-based interventions to help reduce long-term opioid use.
Annals of Internal Medicine >>>
June 25, 2019
Poverty and Excess Length of Hospital Stay in Neonatal Opioid Withdrawal Syndrome
The incidence of neonatal opioid withdrawal syndrome (NOWS) has increased exponentially in the United States over the past several years. Although effective treatment protocols for NOWS have been developed, hospital length of stay (LOS) still vary based on different sociodemographic variables. In this retrospective study of 129 infants with NOWS, increased LOS was strongly correlated with degree of poverty in the mother’s community.
Journal of Addiction Medicine >>>
June 18, 2019
Association between medical cannabis laws and opioid overdose mortality has reversed over time
A 2014 study by Bachhuber et al. created a sensation by showing that state medical cannabis laws were associated with lower-than-expected opioid overdose mortality rates from 1999 to 2010. This recent study used the same methods and data as the prior study but included an additional seven years of data (2010-2017) – a period in which overdose death rates rose sharply and more states legalized recreational and medical marijuana. By including the full 1999–2017 dataset, the authors found that states with medical cannabis laws experienced a 22.7% increase in overdose deaths.
June 11, 2019
Healthy Development as a Human Right: Lessons from Developmental Science
Although the United States still incarcerates more youth than any other country in the world, the justice system is beginning to recognize young adulthood as a distinct phase of development that may require different treatment. Emerging science on brain development is showing us the complexity of prolonged maturation and its impact on society. The scientific community has an obligation to protect young people and their rights for healthy psychological and brain development.
June 4, 2019
Addiction used to be someone else’s problem. Doctors graduating today are eager to take it on
Medical students nationwide are motivated to address the gaps in addiction treatment. Brown University will be the first medical school to graduate an entire class fully trained to prescribe buprenorphine and all four medical schools in Massachusetts have incorporated buprenorphine training into their curriculum. A recent federal opioid legislation will allow schools that provide such training to seek nationwide approval rather than be limited by state licensing authorities.
May 28, 2019
Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study
Alcohol use is a leading risk factor for global disease burden and the World Health Organization (WHO) has set a target date of 2025 for a 10% reduction in alcohol use. However, the results of this comprehensive review on global alcohol consumption predict an overall increase in global consumption, largely accounted for by Southeast Asian and Western Pacific countries. Economic wealth appears to be most strongly associated with increased consumption but religion and governmental policies are also important variables underlying regional differences.
May 21, 2019
Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential — United States, 2003–2017
Increases in stimulant-involved deaths are part of a growing polysubstance landscape. In 2017, among the 70,237 drug overdose deaths that occurred in the United States, 13,942 (19.8%) involved cocaine and 10,333 (14.7%) involved psychostimulants, representing a greater than 30% increase from the year prior. Synthetic opioids appear to be the primary driver of cocaine-involved death rate increases, and recent data point to increasing synthetic opioid involvement in psychostimulant-involved deaths.
CDC Morbidity and Mortality Weekly Report >>>
May 14, 2019
Drug Company Founder, Stripper-Turned-Sales-Rep Convicted of Bribing Doctors to Prescribe Opioid
John Kapoor, the 76-year-old former chairman of Insys Therapeutics (makers of fentanyl sublingual spray - Subsys), was found guilty of racketeering conspiracy after 15 days of jury deliberations. The charges carry up to 20 years in prison and throw a spotlight on the federal government’s efforts to go after those it views as responsible for fueling the nation’s opioid crisis.
May 7, 2019
No Shortcuts to Safer Opioid Prescribing
Since the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in 2016, the medical and health policy communities have largely embraced its recommendations. Unfortunately, some policies and practices have in fact been inconsistent with, and often go beyond, its recommendations. Effective implementation of the guideline requires recognition that there are no shortcuts to safer opioid prescribing.
New England Journal of Medicine >>>
April 30, 2019
The Depths of Despair Among US Adults Entering Midlife
Two demographic trends have generated considerable attention as part of the recent focus on “deaths of despair” among US whites with low education: income stagnation and rising premature mortality from suicides, drug poisoning, and alcoholic liver disease. However, a recent study analyzing data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) questions this narrative and finds a generalized increase in multiple indicators of despair among all White, Black, and Hispanic adults in their 30s. The accompanying commentary discusses the need of developing a reliable framework that conceptualizes and measures despair in order to better understand its relation to premature mortality.
American Journal of Public Health >>>
April 23, 2019
Opinion: Fear, Loathing and Fentanyl Exposure
There have been public health scares before and for the current opioid crisis, one fear is that emergency personnel are at serious risk of passive fentanyl exposure. Although not supported by scientific evidence, many state and government agencies will be spending tens of millions of dollars on protective gear and screening equipment. Such responses will only further separate those who need help from those who can provide it.
The New York Times >>>
April 16, 2019
One of us was a pain patient saved by opioids, the other was addicted to them. We both deserve a solution.
Serious pain and addiction are public health conditions that are widespread, stigmatized and misunderstood. Comprehensive policy changes that address the dueling epidemics of serious pain and addiction in this country are sorely needed and the two sides should work together to effect cultural changes in how pain and addiction are treated.
April 9, 2019
The opioid epidemic is increasingly killing black Americans. Baltimore is ground zero.
For the past two decades, the news media has generally focused on white victims of the opioid epidemic in suburban and rural areas, such as in West Virginia and New Hampshire, but Baltimore has similar overdose death rates (49.1 per 100,000 in 2015). Historic disinvestment and segregation in the area has led to high poverty rates and racial disparities which are exacerbating the opioid crisis.
Vox >>>
April 2, 2019
Op-Ed: We must invest in addiction treatment providers
On March 25, members of ASAM’s Connecticut chapter (CT-SAM) penned an op-ed in the New Haven Register commending Congress for authorizing programs to strengthen the addiction workforce, and calling on Congress to fund them in FY2020’s federal budget. The SUPPORT for Patients and Communities Act authorized $25 million for a student loan repayment program for clinicians who work in substance use disorder treatment in high-need areas. The 21st Century Cures Act authorized $10 million to support training grants for medical professionals who provide treatment for addiction in community-based settings. While these authorizations are a step in the right direction, the op-ed notes that without full funding, medical professionals will continue fighting this epidemic without the resources they need.
March 26, 2019
Aspiring Doctors Seek Advanced Training in Addiction Medicine
The opioid epidemic has made the deficit of addiction-trained doctors painfully apparent which is spurring medical institutions throughout the United States to create fellowships in addiction medicine. Now medical students across the country are getting excited about the field and identifying addiction medicine as part of their future career paths.
National Public Radio (NPR) >>>
March 19, 2019
Outcome Differences in Neonates Exposed In-Utero to Opioids Managed in the NICU Versus Pediatric Floor
In this retrospective study, 235 infants with neonatal abstinence syndrome (NAS) were treated with a protocol using oral morphine in the neo-natal intensive care unit (NICU) or the pediatric unit, depending on physiologic stability at birth. Infants treated on the NICU had a longer length of stay in the hospital and increased number of days of medication treatment suggesting that care outside the NICU could improve short-term outcomes and reduce costs.
Journal of Addiction Medicine (JAM) >>>
March 12, 2019
United loses in court on behavioral health coverage rules
A federal judge has ruled that United Behavioral Health breached its fiduciary duty to patients by using unreasonable and overly restrictive guidelines to make coverage decisions for tens of thousands of mental health and substance use disorder patients. If upheld, the decision could have wide ramification on how insurers provide coverage under federal and state parity laws.
March 5, 2019
A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy
In this study, 886 cigarette smokers were randomized to receive behavioral support along with either nicotine replacement therapy (NRT) or electronic cigarettes (EC) and monitored for abstinence rates. At the end of one year, abstinence rates were 18.0% in the EC group and 9.9% in the NRT group; however, over 80% of abstinent individuals in the EC group were still using electronic cigarettes while only 9% of abstinent individuals in the NRT group were still using NRT.
New England Journal of Medicine
February 26, 2019
Cannabis use in teens linked to risk of depression in young
While the impact of adolescent cannabis use on the development of psychosis has been investigated in depth, little is known about the impact of cannabis use on mood and suicidality in young adulthood. In this study, researchers conducted a systematic review and meta-analysis of over twenty-three thousand individuals and found that cannabis use during adolescence is associated with a significantly increased risk of depression and suicidality in adulthood.
February 19, 2019
Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California
Although most drug epidemics in the United States have disproportionately affected nonwhite communities, the current opioid epidemic is heavily concentrated among low-income white communities. In this population-based study the authors reviewed records from California’s prescription drug monitoring program and compared the rates of prescriptions (opioids, benzodiazepines, and stimulants) with zip code tabulation areas which include racial, ethnic, and income information. Implicit bias and access to care may underlie the racial/ethnic variance.
February 12, 2019
Breaking the Silence
Physicians are people who appear to have it all together but are suffering in silence. Dr. Alisa Duran discusses her reasons for participating in a wellness program for physicians and opening up about addiction.
February 5, 2019
Association Among County-Level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome
Economic forces have shaped the course of the opioid epidemic across the United States. In this study, the authors examined 10-year, county-level data on long-term unemployment, clinician supply, rurality, and rates of neonatal abstinence syndrome (NAS) for 8 states which included 6.3 million births and 47,224 cases of NAS. There was a significant association among higher long-term unemployment, higher mental health clinician shortage areas, and higher county-level rates of NAS
January 29, 2019
Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses
In this study across US counties, marketing of opioid products to physicians was associated with increased opioid prescribing and deaths from prescription opioid overdoses. The number of marketing interactions between physicians and pharmaceutical companies demonstrated a stronger association with mortality than the total dollar amount spent on each physician.
JAMA>>>
January 22, 2019
Predictors for 30-Day and 90-Day Hospital Readmission Among Patients With Opioid Use Disorder
This retrospective, cohort study evaluated consecutive adults with OUD admitted to an academic medical center over a 5-year period. Among patients with OUD taking buprenorphine at the time of hospital admission, 30-day and 90-day hospital readmission was reduced by 53% and 43%, respectively.
Journal of Addiction Medicine (JAM) >>>>
January 15, 2019
Is Marijuana as Safe as We Think?
Permitting pot is one thing; promoting its use is another. Malcolm Gladwell discusses cannabis legalization, a recent report from the National Academy of Medicine, and an alarming book by Alex Berenson.
January 8, 2019
Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children
In this noninferiority randomized clinical trial of 90 children presenting to emergency departments with pain due to acute extremity injuries, intranasal ketamine (1.5 mg/kg) was noninferior to intranasal fentanyl (2 µg/kg) for pain relief. Although ketamine was associated with more adverse events, they were mild and transient.
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MASAM - Massachusetts Society of Addiction Medicine
860 Winter Street
Waltham, MA 02451
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