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

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.

PNAS >>>

Read the 2014 JAMA study

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.

Neuron >>>

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.

The Boston Globe >>>

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.

The Lancet >>>

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.

Time >>>



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.

Los Angeles Times >>>

 

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.

New Haven Register >>>



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.

Modern Healthcare 



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.

JAMA Psychiatry  

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.

JAMA Internal Medicine >>>

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.

JAMA Network

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

JAMA Network

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.

The New Yorker >>>>

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.

JAMA Pediatrics >>>>

ASAM Weekly 2018 (archive)