Nonmedical Opioid Use and Heroin Use in a Nationally Representative Sample of US High School Seniors Drug and Alcohol Dependence Nonmedical use of opioids has become increasingly problematic in recent years with increases in overdoses, treatment admissions, and deaths. An analysis of a representative sample of American high school seniors revealed that 77.3% of heroin users reported lifetime nonmedical opioid use, suggesting that use may be contributing to heroin initiation, which has increased in recent years.
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Editor’s Comments William Haning, MD, FASAM, DFAPA Several days ago, Dr. Richard Soper, Emeritus Editor of ASAM Weekly, put me in mind of work being done toward recovery from amphetamine use disorder. In April of this year, Lara Ray and associates at UCLA published the results of a small but convincing study, in Neuropsychopharmacology, indicating a significant impact of oral naltrexone on the subjective effects of methamphetamine use. Also impending from UCLA is Walter Ling’s group’s examination
of the impact of extended-release methylphenidate (Concerta), an approach suggested by the work of Jari Tihonen in Finland. From the standpoint of ethical administration of an off-label medication, for now it would appear that naltrexone is a more logical initial approach, being not a DEA-scheduled medication.
Evaluating the Effectiveness of First-Time Methadone Maintenance Therapy Across Canada Journal of Addiction Medicine (free ASAM member resource) This study identified regional differences in retention rates and mortality of first-time methadone maintenance therapy. Patients in northern areas were more likely to be retained in treatment than those in southern areas. In the southern regions, there was no significant difference in retention between patients in urban versus rural areas. The authors interpret the data to suggest that patients who have reduced access to treatment experience higher retention rates when they are able to access therapy.
10 Percent of US Adults Have Drug Use Disorder at Some Point in Their Lives National Institutes of Health A survey of American adults revealed that drug use disorder is common, co-occurs with a range of mental health disorders and often goes untreated. The study, funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, found that about 4 percent of Americans met the criteria for drug use disorder in the past year and about 10 percent have had drug use disorder at some time in their lives. Only about 25% of people who have ever had a drug use disorder report receiving any treatment. [Unfortunately, the article employs the nonstandard classification of “drug use disorder” rather than “substance use disorder”; and it is consequently unclear from the citation whether these numbers include alcohol use disorder, which would be expected to itself account
for approximately 10% lifetime prevalence nationally. It is equally unlikely to include tobacco use disorder, for the same reason. – WFH]
Gun Violence Challenges Congress on Mental Health Politico As mental health bills are making their way through both the House and the Senate, some legislators are pushing to include gun control legislation on the mental health initiatives. However, critics say the legislation, which has been endorsed by the National Rifle Association, actually loosens restrictions on gun purchases, under the umbrella of mental health reform. Others worry that linking mass shootings and mental illness will add to the stigma that already haunts the mentally ill, the vast majority of whom are not violent.
Clinical Guideline for the Treatment of Primary Insomnia in Middle-Aged and Older Adults University of Texas These clinical guidelines for the treatment of insomnia review the evidence for various treatment modalities including sleep hygiene education, cognitive behavioral therapy, specific medications, and several non-pharmacological interventions.
Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care Annals of Family Medicine Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) tested the effectiveness of a multifaceted intervention for reducing PIP in primary care. Participants received an intervention incorporating academic detailing; review of medicines with web-based pharmaceutical treatment algorithms that provide recommended alternative-treatment options; and tailored patient information leaflets. At intervention completion, patients in the intervention group had significantly lower odds of having PIP than patients in the control group.
Criminal Activity or Treatable Health Condition? News Media Framing of Opioid Analgesic Abuse in the United States, 1998–2012 Psychiatric News An analysis was conducted of the volume and content of news media coverage of opioid analgesic abuse over a 15-year period, and results suggest that the news media more often frame the problem as a criminal justice issue than a public health crisis. Findings underscore the need for a concerted effort to reframe opioid analgesic abuse as a treatable condition addressable via well-established public and behavioral health approaches.
It’s 3 AM and You’re Feeling Depressed. How Technology is Transforming Mental Health Care The Washington Post Digital behavioral health is increasingly viewed as a way for organizations to improve patients’ overall health, reduce unnecessary and expensive hospitalizations and comply with laws requiring insurers to provide mental health benefits at the same level as benefits for other medical care. One online service, which has been providing internet-based mental health interventions in the United Kingdom for a decade, is now drawing attention from several US health systems looking for ways to increase access to care.
Co-Editors – Kimberly M. Brown, MD; Paul S. Chung, MD; Sarah Martin Domb, MD; Matthew Goldenberg, DO; Angela Gough, DO; Sameer Hassamal, MD; Christian Schrader, MD
Articles included are reviewed on their merit at the discretion of ASAM Weekly’s Editor-in-Chief. Any relationship that exists with products or services advertised with content is coincidental and not an endorsement, guarantee or condemnation of said products or services. Similarly, the views and positions of any content published in ASAM Weekly are not necessarily endorsed by ASAM nor a reflection of ASAM's beliefs and policies. The features are presented as a summary of the contemporary issues being represented and expressed in scientific, governmental, commercial, and media sources across the specialty field of addiction medicine. Contact ASAM Weekly with any comments or feedback.