This Week in Addiction Medicine from ASAM

Online sports betting legalization and behavioral health care use  JAMA Psychiatry This quasi-experimental difference-in-differences study including almost 62 million enrollee-years assessed the association between online sports betting legalization and behavioral health care use.  Researchers found that online sports betting legalization was associated with an increase in the probability of people with employer-sponsored health insurance having a prescription fill or outpatient visit related to depression or anxiety. Associations were more precise and robust for men than women, and legalization was not associated with changes in prescriptions or outpatient visits for a substance use disorder. Results suggest state legalization of online sports betting was associated with measurable increases in mental health care use and may increase strain on the behavioral health system.    Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

Alcohol use screening, brief intervention and referral to treatment cascade of care in the USA: Variation by alcohol use and socio-demographic characteristics Addiction  Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based intervention and researchers used a large data set to assess utilization of each step in the care cascade unconditional on the previous step. Overall, 16% of individuals reported past-year heavy alcohol use and 11% met criteria for alcohol used disorder (AUD). Among those reporting past-year healthcare utilization, 69% reported being screened, with those ≥50 years old and non-white individuals being less likely to be screened. Overall, 8.4% of individuals received BI, with <4% of those reporting heavy alcohol use receiving BI. Among those meeting criteria for AUD only 7% were referred to treatment, while 8% reported treatment in the last year. Women were less likely to receive BI and referral for treatment. Authors note these data highlight the need to better implement SBIRT addressing gaps and differences in access to care cascade.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

The effect of stimulant medications on symptom and treatment outcomes in adults with comorbid attention-deficit/ hyperactivity and substance use disorder: A systematic review and meta-analysis Journal of Attention Disorders ADHD and SUDs have shared genetic vulnerability and 20% of people with a SUD have co-occurring ADHD. This systemic review and meta-analysis assessed the risks and benefits of stimulant treatment in patients with both diagnoses. Seven studies met inclusion criteria; six were randomized controlled trials. Among patients with co-occurring SUD and ADHD, comparing those prescribed stimulants to those not prescribed stimulants, there was no evidence for a difference in substance use, SUD symptoms, substance abstinence, or ADHD treatment adherence. Only 2 of 5 studies showed improvement in ADHD symptoms with stimulant treatment. One study found significantly longer SUD treatment retention in those prescribed stimulants. Although there was no clear evidence of harm associated with treatment with stimulants, they caution that significant limitations in the quality of evidence result in low confidence for all these conclusions.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM  

Projected health and economic outcomes in people who inject drugs in the United States, 2025-2034: A modeling study Open Forum Infectious Diseases This modeling study developed a microsimulation model, the Multimorbidity model to Reduce Infections Associated with Drug use (MYRIAD). Key clinical outcomes and costs were projected from 2025-2034 in the US, including new HIV and HCV cases, hospitalizations for severe injection-related infections, and deaths from drug overdose and injection-related infections. For 3.3 million people who inject drugs over 10 years, the model predicted 487,249 deaths, 29,715 new HIV infections, 218,186 new HCV infections/reinfections, and 1.7 million hospitalizations related to injection drug use, with a projected health care cost of $565 billion.    Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

Psilocybin use, mental health treatment utilization, and unmet treatment need among US individuals with depression Psychological Medicine Psilocybin has shown benefit for treating depression in clinical trials, and in recent years its use has increased among the general population. In this study, researchers utilized the National Survey on Drug Use and Health (NSDUH) to evaluate the association of past-year psilocybin use among those with major depression and mental health treatment use. Overall, among persons with a past-year major depressive episode, 7.3% reported psilocybin use. Researchers found that psilocybin use was not associated with any difference in mental health treatment use, including inpatient, outpatient, and prescription medication. They did find that psilocybin use was associated with perceived unmet mental health treatment needs. The authors note that given the increase in psilocybin use, clinicians should be mindful that patients may have higher psychiatric burden and unmet treatment needs.    Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

Cannabis use and cannabis use disorder among older adults in the USA Addiction Cannabis use has increased among older adults (≥65 years) and to better describe cannabis use and cannabis use disorder (CUD) in this population researchers used the annual National Survey on Drug Use and Health (NSDUH) from 2021 to 2024. Overall, 8.9% of older adults reported past 12-month use and 6.0% reported past 30-day use. Among those who reported past 12-month use, 11.4% met criteria for CUD (76% mild, 20.1% moderate, and 3.9% severe). Those with lifetime arrest, past-year mental illness, tobacco use, other drug use, frequent cannabis use (>300 days in last year), and males were more likely to have CUD.  Of note, 19.9% of older adults reporting cannabis use reported it had been recommended by a doctor. The authors suggest clinicians should be screening for unhealthy cannabis use in this population and early intervention could be of benefit as many have mild CUD.    Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

Adolescent cannabis use disorder following recreational cannabis legalization in California, USA: A population-based interrupted time series study Addiction Adolescent past-year cannabis use trends have remained relatively flat nationally as legalization has spread, but less is known about clinical outcomes such as incident cannabis use disorder (CUD). Researchers evaluated incident CUD case trends among adolescents in California between 2014 and 2020 to assess recreational cannabis legalization (RCL) impact. Incidence of CUD was trending lower between 2014 and 2016 prior to RCL, but post-RCL there was an inflection in the annualized incidence rate , and it started to increase. Notably the increase in incidence trend started after RCL passage, even before implementation of the law. The increasing trend continued after RCL implementation and through 2020. The authors note these findings highlight the importance of monitoring CUD outcomes along with use prevalence to assess public health impacts of cannabis legalization.    Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

Abandonment of prescribed buprenorphine for opioid use disorder, 2020-2024 JAMA Network Open This retrospective cohort study examined characteristics associated with abandonment of newly prescribed buprenorphine, defined as a prescription that was written but not dispensed or filled, and trends in abandonment among adults from 2020 to 2024 to inform efforts to improve buprenorphine access.  Researchers found the proportion of abandoned newly prescribed buprenorphine prescriptions for opioid use disorder increased from 2020 to 2024. Over 1 in 3 patients’ first buprenorphine prescriptions were abandoned in 2024, representing a missed opportunity for treatment initiation and engagement.  Hispanic patients had a higher proportion of prescription abandonment, possibly due to language and pharmacy-level barriers, such as limited retail pharmacies in Hispanic communities and neighborhoods. Increasing opioid overdose death rates among Hispanics highlights the importance of expanding access among this population.    Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

US drug overdose deaths involving stimulants without opioids continued to rise in 2024 Addictive Behaviors Reports Drug overdose deaths (DOD) peaked in 2022 before a decline in rates driven by decrease in opioid-related deaths. We are now in the ‘fourth wave’ of the overdose epidemic, described by DOD involving polysubstance use. As the decline in DOD has been driven largely by decline in deaths related to fentanyl, researchers sought to assess if DOD due to stimulants alone (without opioids) was also seeing a decline. Researchers found that DOD rates related to cocaine without opioids (1.7% increase) and methamphetamines without opioids (2.4% increase) remained stable or increased between 2022 and 2004.  Notably there was some regional variation with the greatest increase in DOD rates seen in the northeast (3.7% for cocaine and 26.7% for methamphetamines). The authors note that stimulant specific interventions may be needed to address the ongoing DOD epidemic.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

US drug overdose deaths that occurred in isolation, 2022–2024 NEJM Evidence Data were obtained from SUDORS (State Unintentional Drug Overdose Reporting System) for 2022-2024. Of 191,577 overdose deaths, 76% occurred in isolation with no opportunity for rescue. Of the deaths in isolation, 73% were in a house or apartment and 23% elsewhere (car, sidewalk, bar). There was a person nearby (but not present) for 29% of the deaths in a house or apartment and 13% of the deaths elsewhere. The authors suggest improved overdose education and reversal agent availability could increase rescues by these nearby persons. For deaths in complete isolation, technologies that monitor vital signs (phone apps, wearable devices) could alert first responders.    Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM