Is the Use of e-Cigarettes While Smoking Associated with Smoking Cessation Attempts, Cessation and Reduced Cigarette Consumption? Addiction In a large-scale study with a one-year follow-up, there appears to have been no advantage and likely considerable disadvantage to using e-cigarettes in the effort to discontinue tobacco use: daily use of e-cigarettes while smoking appears to be associated with subsequent increases in rates of attempting to stop smoking and reducing smoking, but not with smoking cessation. Non-daily use of e-cigarettes while smoking does not appear to be associated with cessation attempts, cessation or reduced smoking.
Editor’s Comments William Haning, MD, FASAM, DFAPA This issue contains seven articles relating directly to tobacco use, six of which carry content that is significantly pertinent to public policy. So, said differently, we have stacked the deck against the folks who were looking for helpful hints on opioid discontinuation and alcohol interventions, at least for this week. I believe you will forgive us, when you consider that this is a small concession to a substance use disorder that arguably has resulted in greater directly-attributable mortality than any other. We did include one article on cannabis.
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FROM JOURNAL OF ADDICTION MEDICINE
Self-Reporting of Smoking Cessation in Cardiac Patients: How Reliable Is It and Is Reliability Associated With Patient Characteristics? Journal of Addiction Medicine (free ASAM member resource) The findings in this study suggest that underreporting of smoking status in cardiac patients who participate in a smoking cessation program is high, especially in those who receive intensive face-to-face counseling. Having a Type D personality seems to be a protective factor, whereas having an intermediate level of education is a risk factor for inaccurate reporting. Biochemical validation in high-risk populations is highly needed, ideally accompanied by alternative forms of verification. Optimal validation testing in smoking cessation studies of cardiac patients is difficult because of high refusal rates, no-show, and organizational difficulties.
Use of Tobacco Tax Stamps to Prevent and Reduce Illicit Tobacco Trade — United States, 2014 Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report Tobacco use is the leading cause of preventable disease and death in the United States. Increasing the unit price on tobacco products is the most effective tobacco prevention and control measure. Illicit tobacco trade (illicit trade) undermines high tobacco prices by providing tobacco users with cheaper-priced alternatives. In the United States, illicit trade primarily occurs when cigarettes are bought from states, jurisdictions, and federal reservation land with lower or no excise taxes, and sold in jurisdictions with higher taxes. Applying tax stamps to tobacco products, which provides documentation that taxes have been paid, is an important tool to combat illicit trade. As of publication, only 4 states have encrypted tax stamps (low counterfeiting risk), and three have no tax stamp at all.
Cannabinoid Dose and Label Accuracy in Edible Medical Cannabis Products Journal of the American Medical Association This study analyzed the dose accuracy of labels from edible medical cannabis products dispensed in 3 US cities. Only 17% of the products sampled were accurately labeled. As the use of cannabis (marijuana) for medical purposes has expanded, a variety of edible products for oral consumption has been developed. An estimated 16% to 26% of patients using medical cannabis consume edible products. Even though oral consumption lacks the harmful by-products of smoking, difficult dose titration can result in overdosing or underdosing, highlighting the importance of accurate product labeling.
Decreased Mortality Rates of Inmates with Mental Illness After a Tobacco-Free Prison Policy Psychiatric Services In a 9+ year study, the salubrious effect of tobacco cessation in prisons was documented. The striking correlation of quick and substantial reduction of mortality among individuals with a mental illness in association with the reduction and subsequent ban of smoking suggests that smoking may play a major role in the reduced life span of persons with mental illness. An important incidental inference is that tobacco interdiction within prisons was both possible and effective.
Risk of Neuropsychiatric Adverse Events Associated with Varenicline: Systematic Review and Meta-Analysis British Medical Journal This meta-analysis found no evidence of an increased risk of suicide or attempted suicide, suicidal ideation, depression, or death with varenicline. These findings provide some reassurance for users and prescribers regarding the neuropsychiatric safety of varenicline. There was evidence that varenicline was associated with a higher risk of sleep problems such as insomnia and abnormal dreams. These side effects, however, are already well recognized.
Menthol Attenuates Respiratory Irritation and Elevates Blood Cotinine in Cigarette Smoke Exposed Mice Plos One Addition of menthol to cigarettes may be associated with increased initiation of smoking. The potential mechanisms underlying this association are not known. Menthol, likely due to its effects on cold-sensing peripheral sensory neurons, is known to inhibit the sensation of irritation elicited by respiratory irritants.
AMA Strengthens Policy on Electronic Cigarettes to Further Protect Youth American Medical Association The American Medical Association has adopted a policy calling for states to set the minimum legal age to purchase e-cigarettes and their liquid nicotine refills at 21, and to require liquid nicotine to be packaged in child-resistant containers.
L-type Ca²⁺ Channel Blockade with Antihypertensive Medication Disrupts VTA Synaptic Plasticity and Drug-Associated Contextual Memory Molecular Psychiatry Drug addiction is driven, in part, by powerful and enduring memories of sensory cues associated with drug intake. As such, relapse to drug use during abstinence is frequently triggered by an encounter with drug-associated cues, including the drug itself. This article, while limited to an examination of neurochemical mechanisms, holds promise for medication-assisted therapy that could include “unlearning” behavioral cueing.
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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.