Comparative Risk Assessment of Alcohol, Tobacco, Cannabis and Other Illicit Drugs Using the Margin of Exposure Approach Scientific Reports This highly-readable article fills an important need, in its effort to authoritatively quantify the respective risks of drugs of abuse, and warrants textbook chapter status. Compared to medicinal products or other consumer products, risk assessment of drugs of abuse has been characterized as deficient. Much of this is based on historical attribution and emotive reasoning. The available data are often a matter of educated guesses supplemented by some reasonably reliable survey data from the developed nations. Only in the past decade, have there been some approaches to qualitatively and quantitatively classify the risk of drugs of abuse. This piece provides an important reference as much for policymakers identifying priorities for intervention, as much as for clinicians.
Editor’s Comments William Haning, MD, FASAM, DFAPA This week’s offering are both numerous and hefty. Your elective reading-time will be sufficiently occupied without my opinions or analyses, but some comments are warranted about the relationships between professionals in addictions, and politicians. The spur to this is the group of policy items below – the Maine Governor’s initiative proposing a reduction in MMTP services in deference to buprenorphine dispensing; and the Portman and Whitehouse efforts to reconsider the CARA (Comprehensive Addiction and Recovery Act). Both invite strong feelings on the parts of legislators and doctors...
CARF is an international, independent, nonprofit accreditor of human service providers and networks. More than 8 million persons of all ages worldwide are served annually in CARF-accredited programs.
Accreditation demonstrates a provider’s commitment to enhancing the lives of persons served.
Visit www.carf.org or call (888) 281-6531 for more information.
FROM JOURNAL OF ADDICTION MEDICINE
Pharmacotherapy of Binge-Eating Disorder: A Review Journal of Addiction Medicine (free ASAM member resource) The purpose of this article is to provide a comprehensive review of pharmacotherapy for binge eating disorder, including new therapeutic approaches such as centrally acting sympathomimetics, nootropics, lisdexamfetamine, and substance use disorder treatment agents such as acamprosate, sodium oxybate, baclofen, and naltrexone. A case is made for overlap between binge eating disorders and conventional substance use disorders. There are significant limitations which should be borne in mind in considering the conclusions, principally bearing on durations of the reviewed studies; as well as on the small study population sizes. While the temptation certainly exists to view eating disorders as analogues of substance use disorders, pharmacotherapy has repeatedly proved a risky area for over interpretation.
An Introduction to Co-Occurring Borderline Personality Disorders and Substance Use Disorders Substance Abuse and Mental Health Services Administration The contract officer on this SAMHSA publication is the same as for the excellent CSAT TAP 21 on counseling competencies. It is a resource guide which introduces professional care providers to borderline personality disorder (BPD). It covers signs and symptoms, with or without co-occurring substance use disorder; monitoring clients for self-harm and suicide; and referrals to treatment. It is a reliable statement of the principles of diagnosis and treatment for those at the counselor level or above, and a useful refresher for those in psychiatry.
Portman and Whitehouse Renew Push to Combat Drug Addiction and Support Americans in Recovery www.Portman.senate.gov With so many Americans subject to drug addiction and overdoses from opiates, US Senators Rob Portman (R-Ohio) and Sheldon Whitehouse (D-R.I.) have renewed their push to reverse the course of this epidemic. In so doing, they are acting on behalf of a population that is not well-positioned to represent itself. The Comprehensive Addiction and Recovery Act of 2015 (CARA) would provide a series of incentives and resources designed to encourage states and local communities to pursue a full array of proven strategies to combat addiction. There is a link to the previously-introduced but rejected 2014 version of this legislation here: CARA 2014.
Australia: Guidelines for the Management of Substance Use During Pregnancy Birth and the Postnatal Period NSW Government This 150 page text demonstrates that good things can come from committees. Lucidly written and well-organized, these clinical guidelines are intended to support a range of health care workers who care for pregnant and breastfeeding women with substance use issues, and their infants and families. The guidelines are based on the best currently available evidence, developed through a rigorous process in which international and Australian research literature was reviewed by experts and consensus achieved. Some of the references are unique to Australia, such as drug risk categories, but otherwise the diagnostic and therapeutic recommendations are generalizable.
The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction Annual Reviews Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. In this 15-page article, the authors make a case for a re-focusing of epidemiologic and interventional consideration from solely the non-medical use of opiates (e.g., heroin), to include the pathologic consequences of iatrogenic over-prescription.
Smoking and Mortality — Beyond Established Causes The New England Journal of Medicine An objective of this well-supported article was to expand the realm of illnesses leading to death that may be ascribed to tobacco smoking: a substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated.
Maine Governor LePage Proposes Eliminating Medicaid Funding for Opioid Treatment Programs ASAM This is a temperate review of a potentially destructive and ill-advised measure. It takes note of the fact that buprenorphine is by no means an appropriate substitute for methadone in all cases of opioid dependence, and invites re-examination by the proposal’s sponsors. Governor LePage of Maine recently proposed eliminating Medicaid funding for opioid treatment programs in Maine. He plans to “transition” individuals recovering from opioid addiction from methadone to buprenorphine-containing medications. This plan will have profound public and personal health consequences. For many patients recovering from opioid addiction, methadone is the recommended and more effective treatment modality...
Change in Opioid Dose and Change in Depression in a Longitudinal Primary Care Patient Cohort Pain Depression is associated with receipt of higher doses of prescription opioids. It is not known whether the reverse association exists in that an increased opioid dose is associated with increased depression. Questionnaires were administered to 355 patients with chronic low back pain at baseline and 1-year and 2-year follow-up. This supports current pain management theory, which suggests an exacerbating effect on pain perception as well as on mood, with chronic opioid administration.
The Problem with Treating Pain in America Time Chronic pain affects an estimated 100 million Americans, and between 5 to 8 million use opioids for long-term pain management. In September, the NIH held a workshop to review chronic pain treatment with a panel of seven experts and more than 20 speakers. The NIH also reviewed relevant research on how pain should be treated in the United States.
Enduring Good Memories of Infant Trauma: Rescue of Adult Neurobehavioral Deficits via Amygdala Serotonin and Corticosterone Interaction Proceedings of the National Academy of Sciences This tantalizingly-titled study uses rat pups for describing counterintuitive neurochemical changes associated with infant trauma. It is a challenging basic science piece that may inform our understanding of antidepressant actions. “Infant trauma induces preference learning about trauma-linked cues but negatively programs neurobehavioral development. Despite clinical evidence that trauma-linked cues remain powerful throughout life, the mechanisms underlying the interaction between infant trauma cues and the long-term effects of trauma are unknown. Using a rodent model of trauma bonding, which produces a life-long preferred odor and enduring effects that parallel the sequelae of child abuse, the authors show that the infant trauma odor rescues adult depressive-like behavior and amygdala dysfunction.”
ASAM Represented in National Press Foundation Webinar National Press Foundation ASAM President Dr. Stuart Gitlow and distinguished member Dr. Richard Saitz stopped by the National Press Foundation for an informative interview! In this webinar, they jointly address issues surrounding naloxone, effects of drug use, and family support.
Brendan McEntee, Associate Director, Publications and Communications, 301.656.3920
Emily McMartin, Communications and New Media Specialist AdvertiseView media kit Please direct customer service inquiries topubs@asam.org.
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.