Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence Journal of the American Medical Association The last sentence of this abstract deserves emphasis. The most appreciable quality of this study is the evidence for the value of early engagement. It is possible that the lack of urine drug study validation of self-reports reflects the brevity of the study (30 days). Among opioid-dependent patients, ED-initiated buprenorphine treatment vs brief intervention and referral significantly increased engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services but did not significantly decrease the rates of urine samples that tested positive for opioids or of HIV risk. These findings require replication in other centers before widespread adoption.
Editor’s Comments William Haning, MD, FASAM, DFAPA Three of the following articles relate to alcohol use comorbidity, remarking once again the interface between addiction and somatic injury. They provide a significant reminder of why there is a Society of Addiction Medicine in addition to an Academy of Addiction Psychiatry, and of the Society’s multidisciplinary roots. – W. Haning
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Narrative of Discovery: In Search of a Medication to Treat Methamphetamine Addiction National Institute on Drug Abuse An encouragement to new investigators, this piece from the National Institute on Drug Abuse describes one researcher's journey toward developing an effective medication-assisted treatment (MAT) strategy for methamphetamine use, employing novel agents. Her more recent focus appears to have been on methamphetamine effects, rather than on craving or on withdrawal. Pharmacologist Dr. Linda Dwoskin and her research team have generated a dozen compounds that they believe might help people overcome addiction to methamphetamine. Over the coming years, Dr. Dwoskin plans to single out the most promising one, complete the requirements for obtaining approval from the Food and Drug Administration to test it in patients, and then evaluate it in clinical trials.
Report Outlines Benefits of Raising Minimum Age to Buy Cigarettes Journal of the American Medical Association If the minimum age of legal access to tobacco products were raised now to 21 years, there would be approximately a 12% decrease in smoking prevalence in 2100, according to a report by the Institute of Medicine (http://bit.ly/1wz4p0i). Based on a simulation model, there would be approximately 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer, and 4.2 million fewer years of life lost for those born between 2000 and 2019. The article does not attempt to address the future of nicotine vaporizers, but focuses on the adversity of tobacco leaf products.
National Prevention Week Starts Sunday! Substance Abuse and Mental Health Administration National Prevention Week is a SAMHSA-supported annual health observance dedicated to increasing public awareness of, and action around, substance abuse and mental health issues. National Prevention Week 2015 will take place May 17-23, 2015. The theme for 2015 is “The Voice of One, the Power of All.” Explore the National Prevention Week website to learn more about how you can get involved, from planning a community event to participating in the “I Choose” Project. This link also familiarizes clinicians with the public face of SAMHSA.
Do Alcohol Use Disorders Impact Long Term Outcomes from Intensive Care? A Prospective Observational Cohort Study Critical Care There is limited evidence regarding the impact of alcohol use disorders on long term outcomes from intensive care. The aims of this study were to analyze the nature and complications of alcohol related admissions to intensive care and determine whether alcohol use disorders impact on survival at six months post ICU discharge. This was an 18 month prospective observational cohort study in a 20 bed mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk, harmful/hazardous, or alcohol dependency. Those with alcohol dependency had a twofold increase in odds risk for mortality associated with septic shock.
Patient Education for Alcohol Cessation Intervention at the Time of Acute Fracture Surgery BMC Surgery This is a prospectus only. This protocol describes a randomized clinical trial that aims to evaluate the effect of a new gold standard program for alcohol cessation intervention in the perioperative period regarding postoperative complications, alcohol intake and cost-effectiveness. Patients with hazardous alcohol intake are overrepresented in emergency departments and surgical wards. These patients have an increased risk of postoperative complications with prolonged hospital stays and admissions to intensive care unit after surgery. In elective surgery, preoperative alcohol cessation interventions can reduce postoperative complications, but no studies have investigated the effect of alcohol cessation intervention at the time of acute fracture surgery.
Department of Human Services Seeks Proposals to Address Pennsylvania's Heroin and Opioid Crisis Pennsylvania Department of Human Services As part of Governor Wolf's proposed 2015-16 budget, the Department of Human Services (DHS) announced that it is seeking proposals for two robustly-funded pilot programs to provide additional services to address heroin and opioid addiction. Heroin and other opioid overdose is a leading cause of preventable death in the country; within the Commonwealth, there has been an increase in overdose deaths from heroin and other opioids across the age span: in the last 20 years, Pennsylvania has seen a 570 percent increase in overdose deaths.
Heavy Alcohol Use and Suicidal Behavior among People Who Use Illicit Drugs: A Cohort Study Drug and Alcohol Dependence People who use illicit drugs (PWUD) are known to experience high rates of suicidal behavior. While heavy alcohol use has been associated with suicide risk, its impact on the suicidal behavior of PWUD has not been well characterized. Therefore, the authors examined the relationship between heavy alcohol use and suicidal behavior among PWUD in Vancouver, Canada. Therefore, the authors examined the relationship between heavy alcohol use and suicidal behavior among PWUD in Vancouver, Canada, using data derived from two studies of 1757 subjects over 8 years. They discovered that heavy alcohol use, apart from other factors, was alone associated a twofold increase in suicide attempts.
I Spent Seven Years Locked in a Human Warehouse Politico Magazine “On the morning of June 24, 2007, I kicked in my elderly neighbors’ door and brutally beat them with a broom handle. I then immediately called the police to tell them what I had done. I was arrested and charged with first-degree burglary, second- and third-degree assault and third-degree unlawful imprisonment. If my motive for this attack had been a dispute over money or drugs, my story would be common, hardly remarkable…” A first-person narrative, this article articulately describes a common event in the forensic psychiatric world. It also provides a sample of the ambivalence that even those with significant insight may have, regarding their own criminal commitment verdicts.
Spatiotemporal Control of Opioid Signaling and Behavior Neuron Optogenetics is now a widely accepted tool for spatiotemporal manipulation of neuronal activity. However, a majority of optogenetic approaches use binary on/off control schemes. Here, the authors extend the optogenetic toolset by developing a neuromodulatory approach using a rationale-based design to generate a Gi-coupled, optically sensitive, mu-opioid-like receptor, which they term opto-MOR. The authors demonstrate that opto-MOR engages canonical mu-opioid signaling through inhibition of adenylyl cyclase, activation of MAPK and G protein-gated inward rectifying potassium (GIRK) channels and internalizes with kinetics similar to that of the mu-opioid receptor.
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