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This Week in the Â鶹´«Ã½ÔÚÏß Weekly

An opinion piece from â€¯uses the ship of Theseus to explore how recovery is a journey of changes in neuroscience and life. What starts off as addiction leads to connection, and from there something better evolves. 

Often these connections are straightforwardly built on fellowship. This is well demonstrated by 12-step programs but even they don’t always connect in the most empathic way. Historically, these programs have shunned medications, but as the individual changes in recovery so too should the programs that support an individual’s recovery (). &²Ô²ú²õ±è;

This willingness to change is fundamental in addiction treatment. Most often it’s portrayed as motivating the individual, such as taking medications for alcohol use disorder (), but it’s also about change in the practitioners, such as being more inclusive with interdisciplinary teams () or being open to the idea that obesity and addiction are both brain diseases (). â¶Ä¯&²Ô²ú²õ±è;

Inevitably, things will change (and hopefully for the better). Opioid settlement funds are filling the coffers of local governments but not always paying for what many would expect (). The Department of Veterans Affairs (VA) is expanding trials for psychedelic-assisted therapy (), while contingency management is finally being recognized after three decades of (mostly) VA research (). Even unions seem to have a protective effect on overdose and despair, but membership rates have declined over the years ().

Change comes not without challenges. An opinion piece in â€¯warns that medical societies are facing an “existential crisis” of purpose and must change—but there are many societies, of many shapes and sizes. Some might change plank by plank, some will change into something new, while others might not be able to change at all. Those that closely identify with change will better embrace the journeys ahead. 

And on this Veterans Day, we extend our thanks to those who have served, those who currently serve, and their families.  

Thanks for reading, 

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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JAMA Network Open 

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 one week after the first was well tolerated in both the RI and SI arms. These findings support RI for extended-release buprenorphine induction in high-risk patients and demonstrate the feasibility of administering the first two doses at least one week apart. 

Research and Science

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JAMA Network Open 

This study used data from the Québec Longitudinal Study of Child Development to examine associations between adolescent cannabis use (15-17 years) and later medical diagnoses (18-23 years). Participants’ (n=1,591) cannabis use was labeled as: no adolescent cannabis use (60%), late-onset infrequent use (>15 years old and <1 use/month, 20%), and early-onset frequent use (<15 years old and >1 use/month, 20%). Individuals with early-onset frequent use had higher odds of later experiencing any mental disorder (aOR 1.5) and any physical condition (aOR 1.9). Late-onset infrequent use was associated only with a later physical condition (aOR 1.6). The specific physical conditions associated with early-onset frequent use were injury and poisoning (aOR 1.4) and other physical disease (aOR 1.5); late-onset infrequent use wasn’t associated with either of these. Early-onset frequent cannabis use was associated with mental and physical conditions in young adulthood. 

Journal of Studies on Alcohol and Drugs 

Using self-report data of participants in the Collaborative Study on the Genetics of Alcoholism (COGA), researchers investigated offspring alcohol use outcomes as a function of unremitted and remitted parental alcohol use disorder (AUD).  Evidence that parental remission can help mitigate the risk associated with parental AUD and increase the likelihood of remission in affected offspring was limited and mixed based on continental group and sex. These nuanced outcomes highlight the complex interplay of parental AUD status and offspring’s alcohol-related behaviors. 

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Journal of Substance Use and Addiction Treatment 

Researchers surveyed patients with AUD to assess factors that may be associated with initiation of medications for AUD (MAUD). Researchers assessed knowledge about the medications, beliefs about efficacy, and stigma around the medications. Overall knowledge about AUD-approved medications was limited, with knowledge of naltrexone the most common. A little over half (55%) believed MAUD in general was effective in helping to treat AUD, with naltrexone viewed the most favorably. Stigma toward MAUD was reported to be very low. The researchers found that knowledge about specific medications and belief in efficacy was associated with intention to take the MAUD. Given these findings and the relative limited knowledge of MAUD, the authors suggest education around this medication in this population could improve MAUD uptake.  

Learn More

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Journal of the Endocrine Society

This is a review paper that summarizes the evidence for Glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of substance use disorders (SUDs). The review outlines the preclinical studies that have shown the effects of GLP-1RAs in reducing the use of various substances, including alcohol, opioids, nicotine, and psychostimulants. The authors also recap the few randomized controlled trials exploring the impact of GLP-1RAs on various substances, and highlight the following areas for future research: 1) basic science studies to understand the mechanism of action of GLP-1RAs in addiction treatment, and 2) clinical studies to evaluate the safety and efficacy of GLP-1RAs for SUDs, as well as combination therapy with other treatments for SUDs. 

Journal of Substance Use and Addiction Treatment

This is a discussion of resistance to medications for opioid use disorder (MOUD) in some 12-step communities, authored by three addiction medicine physicians in long-term recovery. They note that the co-founder of Alcoholics Anonymous (AA) wrote, “We have seen more than a few AA members slip badly while clinging to pills …” In 2024, Narcotics Anonymous official literature stated, “…people…on drug replacement therapy…are welcome.” Nevertheless, stigma persists in some groups. Families also push for abstinence-only recovery. The authors advise educating families that MOUD reduces mortality and prevents relapse. For patients, the authors reduce shame by normalizing ambivalence and sharing their lived experience in early recovery, having discomfort about medication. They also use motivational interviewing techniques to explore patients’ ambivalence. Recovery communities can evolve as they have in the acceptance of antidepressants. 

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Journal of General Internal Medicine  

Alcohol use attributable deaths account for over 170,000 deaths, but less than 2% of persons with AUD receive evidence-based MAUD. The authors discuss a couple of models that could increase access to MAUD in primary care settings, including “coordinated care” models collaborating with pharmacists and “shared care” models with addiction specialists initiating treatment in primary care settings. While both models offer promise there are also barriers. The suggested interdisciplinary training programs and financial reimbursement aligned with such models could increase MAUD access and address a significant and under-acknowledged public health crisis.

The American Journal of Psychiatry 

This editorial argues for increased implementation of contingency management (CM) for SUDs in the United States. The authors cite numerous studies including Coughlin’s recent study which showed an association between CM for stimulant use disorder (StUD) and reduction in all-cause mortality. The authors emphasize that despite CM’s strong evidence base, it is extremely underutilized in the US. In light of the increasing rates of stimulant-related overdose deaths, the implementation of CM for StUD is increasingly critical. The authors argue that we have an obligation to improve access to CM for a variety of SUDs, particularly given that strong data for CM has existed for over 30 years. 

In the News

MedPage Today

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The Conversation

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Medscape

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KFF Health News

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Military.com

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