Tobacco Smoking Cessation in Adults and Pregnant Women: Behavioral and Pharmacotherapy Interventions – Final Recommendation Statement US Preventive Services Task Force The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)–approved pharmacotherapy for cessation to adults who use tobacco…
A Survey of ASAM Members' Knowledge, Attitudes, and Practices in Urine Drug Testing Journal of Addiction Medicine (free ASAM member resource) Urine drug testing (UDT) is widely used and highly integrated into the assessment and management of people with addictions undergoing treatment by ASAM members. Greater than 94% of respondents use testing to determine adherence, to monitor abstinence, and to detect an early relapse. The majority felt confident in their ability to interpret and use UDT results, and the vast majority had reportedly used it in changing patient management. Education gaps do exist, however, and should be the focus of future education efforts on UDT.
FREE Online CME/CE Tools for Motivational Interviewing
NIDA is offering 2 FREE CME opportunities for Motivational Interviewing. These online simulations guide providers of adult and adolescent patients through MI skills-building with real time testing in a clinical setting.
ASAM National Practice Guideline and Associated Products Now Available ASAM On September 24th, ASAM announced the release of the National Practice Guideline on Medications for the Treatment of Addiction Involving Opioid Use and associated products at the National Press Club in Washington, DC. The products include an article authored by Kyle Kampman, MD and Margaret Jarvis, MD, FASAM available ahead of print online, pocket guide and phone application, slide deck and speaker notes, and the full guideline in journal format. The guideline website also includes information on educational webinars; the first being held October 28.
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How Fast and How Often: The Pharmacokinetics of Drug Use are Decisive in Addiction Neuroscience and Biobehavioral Reviews How much, how often and how fast a drug reaches the brain determine the behavioral and neuroplastic changes associated with the addiction process. Despite the critical nature of these variables, the drug addiction field often ignores pharmacokinetic issues, which the authors argue can lead to false conclusions. The authors review the clinical and pre-clinical data which demonstrate that pharmacokinetic variables, including the speed of drug onset and of intermittent patterns of drug intake, play a decisive role in determining behavioral and neurobiological outcomes in addiction. This has significant implications for refining animal models of addiction and for better understanding the neuroadaptations that are critical for the disorder.
Long-term Nicotine Replacement Therapy: A Randomized Clinical Trial JAMA Internal Medicine The US Food and Drug Administration adopted labeling for nicotine patches to allow use beyond the standard 8 weeks. This decision was based in part on data showing increased efficacy for 24 weeks of treatment. Authors of this study examined whether the use of nicotine patches beyond 24 weeks provides additional therapeutic benefit. Smokers were randomized to 8 weeks, 24 weeks, or 52 weeks of nicotine patch treatment. Results confirmed that those who were still on the patch at 24 weeks did have increased abstinence rates compared to those who stopped using the patch at 8 weeks. However, by 52 weeks there was no difference in the abstinence rates of those who were still on nicotine patches compared to those who stopped using patches at 8 or 24 weeks. These findings support the efficacy of use of nicotine patches up to 24
weeks but not beyond.
Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomized, Open-Label Trial The Lancet Although this study had several limitations—eg, it only included participants incarcerated for fewer than 6 months, the authors showed that forced withdrawal from methadone on incarceration reduced the likelihood of prisoners re-engaging in methadone maintenance after their release. Continuation of methadone maintenance during incarceration could contribute to greater treatment engagement after release, which could in turn reduce the risk of death from overdose and risk behaviors.
Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use JAMA Internal Medicine Prescription Drug Monitoring Program (PDMP) and pill mill laws are among the principal means states use to reduce prescription drug abuse and diversion. This study sought to quantify the effect of Florida’s PDMP and pill mill laws on overall and high-risk opioid prescribing and use, using Georgia as a control state. Florida’s PDMP and pill mill laws were associated with modest decreases in opioid prescribing and use. Decreases were greatest among prescribers and patients with the highest baseline opioid prescribing and use.
Cortical Representation of Afferent Bodily Signals in Borderline Personality Disorder JAMA Psychiatry The ability to perceive and regulate one’s own emotions has been tightly linked to the processing of afferent bodily signals (interoception). Thus, disturbed interoception might contribute to the core feature of emotional dysregulation in borderline personality disorder (BPD). Heartbeat evoked potentials (HEPs), an indicator of the cortical representation of afferent signals from the cardiovascular system, were investigated using electroencephalograms and parallel electrocardiograms in 34 medication-free patients with BPD, 31 healthy volunteers, and 17 medication-free patients with BPD in remission. The results indicate state-dependent deficits in the cortical processing of bodily signals in patients with BPD, which appear to be associated with core features of BPD, as well as an improvement in cortical representation of
bodily signals in BPD patients with symptom remission. Authors recommend the integration of techniques to strengthen bodily awareness in psychotherapeutic interventions of BPD.
The Effects of Piracetam on Heroin-Induced CPP and Neuronal Apoptosis in Rats Drug and Alcohol Dependence Piracetam is a positive allosteric modulator of the AMPA receptor that has been used in the treatment of cognitive disorders for decades. Recent surveys and drug analyses have demonstrated that a heroin mixture adulterated with piracetam has spread rapidly in patients with heroin addiction in China. In this study, the effect of piracetam on the reward properties of heroin was assessed by conditioned place preference (CPP) in rats. Results indicate that piracetam potentiates the heroin-induced CPP and protects neurons from heroin-induced apoptosis. The protective role of heroin mixed with equivalent piracetam (HP) might be related to the restoration of β-endorphin levels by piracetam. These findings may provide a potential interpretation for the growing trend of the HP abuse among addicts in China.
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