Showing papers on "Addiction medicine published in 2021"

Reorganization of Substance Use Treatment and Harm Reduction Services During the COVID-19 Pandemic: A Global Survey

Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups. Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted. Conclusions: Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.

Recommended Use of Terminology in Addiction Medicine.

Abstract: T he American Society of Addiction Medicine (ASAM)’s Journal of Addiction Medicine and other leading journals have encouraged the use of precise nonstigmatizing terminology. Furthermore, the International Society of Addiction Journal Editors (ISAJE) published a recommendation statement against the use of stigmatizing terms. The ASAM has published policy statements on the issue of terminology. The US Office of National Drug Control Policy posted a draft statement on changing the language in our field. Stigmatizing terms can negatively impact quality of care. For example, research demonstrates that when patients are described as having substance ‘‘abuse’’ instead of a ‘‘disorder,’’ clinicians are more likely to recommend punitive approaches. Examples of terms that can be stigmatizing include the use of the terms ‘‘alcoholic,’’ ‘‘abuser,’’ ‘‘drunk,’’ ‘‘user,’’ ‘‘addict,’’ or ‘‘junkie.’’ While the use of terms such as ‘‘alcoholic’’ and ‘‘addict’’ are acceptable in 12-step or other nonmedical settings, these terms could easily be replaced with more medically defined and less stigmatizing terms that incorporate person-first language (eg, patient with ‘‘alcohol use disorder’’ and not ‘‘alcoholic,’’ etc). Several terms are preferred when discussing the spectrum of unhealthy alcohol and other drug use. Much of this section appeared in an ASAM policy statement.

A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic

Abstract: Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing, and "lockdown" measures have affected drug and alcohol supply chains and subsequently their availability, price, and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals' perceived changes in drug and alcohol supply, price, use pattern, and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered "decreased" or "increased") a decrease in drug supply (69.0%) and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported, while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns, and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to people with SUD.

Women, opioid use and addiction

Abstract: In the midst of the current coronavirus pandemic, the United States continues to struggle with an ongoing opioid epidemic, initially fueled by widespread prescribing of opioid medications during the 1990s. The primary reason for prescribing opioids is to treat pain. Women have more acute and chronic pain and have been prescribed these drugs in significantly greater numbers than men. Comparison of women and men with chronic pain also shows that women receive the majority of prescription opioids, and the use of these prescribed medications became the major pathway to misuse and addiction for women. Yet, recognition of the extent of women's exposure to opioids and the attendant consequences has been limited. Attempts to stem the overall tide of the epidemic focused on reducing the availability of prescription opioids. However, as these medications became more difficult to obtain and treatment opportunities were limited, many turned to other synthetic opioids, such as heroin and fentanyl. Thus, the public health crisis of opioid addiction has endured. This paper highlights the importance of understanding differences among women and men in opioid use and its biological and psychosocial effects to advance the gender-based treatment approaches and effective public health policy.

Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study.

Abstract: Background Trust is essential in patient-physician relationships. Hospitalized patients with substance use disorders (SUDs) often experience stigma and trauma in the hospital, which can impede trust. Little research has explored the role of hospital-based addictions care in creating trusting relationships with patients with SUDs. This study describes how trust in physicians changed among hospitalized people with SUDs who were seen by an interprofessional addiction medicine service. Methods We analyzed data from hospitalized patients with SUD seen by an addiction consult service from 2015 to 2018. Participants completed surveys at baseline and 30 to 90 days after hospital discharge. Follow-up assessments included open-ended questions exploring participant experiences with hospitalization and the addiction consult service. We measured provider trust using the Wake Forest Trust scale. We modeled trust trajectories using discrete mixture modeling, and sampled qualitative interviews from those trust trajectories. Results Of 328 participants with SUD who had prior hospitalizations but had not previously been seen by an addiction consult service, 196 (59.8%) had both baseline and follow-up trust scores. We identified 3 groups of patients: Persistent-Low Trust, Increasing Trust, and Persistent-High Trust and 4 qualitative themes around in-hospital trust: humanizing care, demonstrating addiction expertise, reliability, and granting agency. Conclusions Most participants retained or increased to high trust levels after hospitalization with an addiction consult service. Addiction consult services can create environments where healthcare providers build trust with, and humanize care for, hospitalized patients with SUD, and can also mitigate power struggles that hospitalized patients with SUD frequently experience.

Adapting inpatient addiction medicine consult services during the COVID-19 pandemic.

Abstract: We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul’s Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut. ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones. We believe that ACS were essential to hospitals’ readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises.

Hospital Buprenorphine Program for Opioid Use Disorder Is Associated With Increased Inpatient and Outpatient Addiction Treatment.

Abstract: Despite evidence that medications for patients with opioid use disorder (OUD) reduce mortality and improve engagement in outpatient addiction treatment, these life-saving medications are underutilized in the hospital setting. This study reports the outcomes of the B-Team (Buprenorphine-Team), a hospitalist-led interprofessional program created to identify hospitalized patients with OUD, initiate buprenorphine in the inpatient setting, and provide bridge prescription and access to outpatient treatment programs. During the first 2 years of the program, the B-Team administered buprenorphine therapy to 132 patients in the inpatient setting; 110 (83%) of these patients were bridged to an outpatient program. Of these patients, 65 patients (59%) were seen at their first outpatient appointment; 42 (38%) attended at least one subsequent appointment 1 to 3 months after discharge from the hospital; 29 (26%) attended at least one subsequent appointment between 3 and 6 months after discharge; and 24 (22%) attended at least one subsequent appointment after 6 months. This model is potentially replicable at other hospitals because it does not require dedicated addiction medicine expertise.

Flattening the curve of COVID-19 for medical education in psychiatry and addiction medicine.

Abstract: Objective:To describe the context, challenges and responses to COVID-19 public health measures for medical education in psychiatry, with an emphasis on sharing strategies for ongoing COVID-19 chall...

Time to ACT: launching an Addiction Care Team (ACT) in an urban safety-net health system.

Abstract: Across the USA, morbidity and mortality from substance use are rising as reflected by increases in acute care hospitalisations for substance use complications and substance-related deaths. Patients with substance use disorders (SUD) have long and costly hospitalisations and higher readmission rates compared to those without SUD. Hospitalisation presents an opportunity to diagnose and treat individuals with SUD and connect them to ongoing care. However, SUD care often remains unaddressed by hospital providers due to lack of a systems approach and addiction medicine knowledge, and is compounded by stigma. We present a blueprint to launching an interprofessional inpatient addiction care team embedded in the hospital medicine division of an urban, safety-net integrated health system. We describe key factors for successful implementation including: (1) demonstrating the scope and impact of SUD in our health system via a needs assessment; (2) aligning improvement areas with health system leadership priorities; (3) involving executive leadership to create goal and initiative alignment; and (4) obtaining seed funding for a pilot programme from our Medicaid health plan partner. We also present challenges and lessons learnt.

Computational Mechanisms of Addiction: Recent Evidence and Its Relevance to Addiction Medicine

Abstract: In this article, we provide a brief review of recent computational modelling studies of substance use disorders (SUDs), with a focus on work published within the last 5 years. While reinforcement learning (RL) approaches are most prominent in recent studies, we also review work from other perspectives that focus on Bayesian (active) inference and perceptual processing. Recent work in RL shows evidence that goal-directed (model-based) planning processes are impaired in SUDs, leading to impulsive, habitual decision processes focused on short-term reward despite long-term negative consequences. Bayesian approaches offer a complementary perspective, suggesting that drug-induced overconfidence in prior expectations prevents substance users from appropriately updating their beliefs in the face of negative outcomes. Recent neurocomputational studies have shown promise in differentiating those who will and will not relapse. Computational modelling has made progress in identifying specific prospective decision-making processes that are impaired in SUDs, but further research is necessary before these approaches can directly inform medical practice on an individualized level.

Civil Commitment for Substance Use Disorders: A National Survey of Addiction Medicine Physicians.

Abstract: BACKGROUND Civil commitment (CC) for substance use disorders (SUDs) is a legal mechanism, initiated by family members, healthcare professionals, or others, that compels individuals with substance use problems into involuntary treatment. With the recent rise of US overdose deaths, more states are considering these laws. Yet little is known about physicians' perspectives regarding CC in treating patients with SUDs. METHODS We conducted a web-based survey of American Society of Addiction Medicine (ASAM) physician members regarding their awareness of, attitudes towards, and experiences with CC for adults with SUDs. RESULTS One hundred sixty-five addiction physicians completed the survey; 60.7% favored, 21.5% opposed, and 17.8% were unsure regarding CC for SUDs. More than a third (38.4%) were unfamiliar with these laws and more than a quarter (28.8%) were unsure if CC for SUDs was permitted in their state. Support for CC was strongest for SUDs involving heroin (79.0%), alcohol (74.7%), and nonheroin opioids (74.7%). Those opposing CC were more likely to believe it would jeopardize patient rapport (P < 0.001), would be ineffective for unmotivated individuals (P < 0.001), and should only be permitted for certain substances (P = 0.007). A majority of respondents endorsed the need for more clinician education (91.5%) and research (87.1%) on this topic. CONCLUSIONS Although most addiction physicians in this study approve of CC for SUDs, enthusiasm for this compulsory intervention is mixed with strongest support for patients with opioid and alcohol use disorders. At the same time, many respondents are unfamiliar with these laws and most believe more education and research are needed.

The role of spirituality in addiction medicine: a position statement from the spirituality interest group of the international society of addiction medicine.

Abstract: Spirituality is a construct that is reflected in a diversity of strongly felt personal commitments in different cultural and national groups. For persons with substance use disorders (SUDs), it can serve as a component of the recovery capital available to them. This position statement reviews empirical research that can shed light on psychological, social, and biological aspects of this construct. On this basis, the Spirituality Interest Group of the International Society of Addiction Medicine (ISAM) makes recommendations for how this construct can be incorporated into research and clinical care.

Integrating DATA 2000 waiver training into undergraduate medical education: The time is now.

Abstract: Background: Medications for opioid use disorder (MOUD) significantly reduce morbidity and mortality from opioid use disorder (OUD). To prescribe MOUD, physicians must obtain a DEA waiver through requirements outlined in the Drug Addiction Treatment Act of 2000 (DATA 2000). We developed an Addiction Medicine curriculum that features DATA 2000 waiver training at the Robert Larner, MD College of Medicine (LCOM). Methods: All third-year medical students completed a virtual DATA 2000 waiver training at the commencement of clinical clerkships. We conducted a curriculum needs assessment followed by pre- and post-training surveys to evaluate MOUD pharmacology knowledge and best prescribing practices. Results: Of LCOM students surveyed, 77.6% reported interest in being waivered to prescribed MOUD for OUD treatment. Third-year medical students demonstrated increases in both MOUD Pharmacology Knowledge from 64.2% to 84.8% (chi-squared = 40.8; p < .001) and MOUD Best Prescribing Practices from 55.9% to 75.2% (chi-squared = 29.9; p < .001). Discussion: Surveys showed the majority of students felt waiver training was relevant to their future practice. An online DATA 2000 waiver training format effectively improved student knowledge of MOUD. Conclusion: This curriculum exposed medical students to DATA 2000 waiver training, MOUD pharmacology and best practices, and increased the number of future physicians eligible to treat OUD using MOUD.

State of the Art in Substance Use Prevention and Early Intervention: Applications to Pediatric Primary Care Settings.

Abstract: With changes to drug-related policies and increased availability of many drugs, we currently face a public health crisis related to substance use and associated health consequences. Substance use and substance use disorders (SU/SUDs) are complex developmental disorders with etiologies that emerge through the intergenerational transmission of biological, familial, and environmental factors. The family ecosystem both influences and is influenced by SU/SUDs, particularly in children and adolescents. Family dynamics and parent functioning and behaviors can represent either risk or protective factors for the development of SU/SUDs in children. Primary care providers who provide care for children, adolescents, and families are in an ideal position to deliver prevention messages and to intervene early in the development of substance misuse and SUD among their patients. Despite recommendations from the American Academy of Pediatrics, few pediatric primary care providers provide anticipatory guidance to prevent or screen for substance misuse. Many barriers to those practices can be overcome through the integration and application of findings from the field of prevention science and the many lessons learned from the implementation of evidence-based interventions. Consideration of the implications of prevention science findings would help clarify the relevant roles and responsibilities of the primary care clinician, and the benefit of referral to and consultation from addiction specialists. Additionally, the past decade has seen the development and validation of a continuum of evidence-based prevention and early SU/SUD intervention activities that can be adapted for use in primary care settings making wide-spread implementation of prevention feasible. We propose a paradigm shift away from a model based on diagnosis and pathology to one upstream, that of family-focused prevention and early intervention. Adapting and scaling out empirically based prevention and early SU/SUD interventions to primary care settings and removing barriers to collaborative care across primary care, addiction medicine, and mental health providers offer the potential to meaningfully impact intergenerational transmission of SU/SUD - addressing a leading health problem facing our nation.

Drug overdose deaths, addiction neuroscience and the challenges of translation

Abstract: In this article, we argue that the rapid rise in drug overdose deaths in America is a tragedy that draws attention to fundamental conceptual and experimental problems in addiction science that have significant human consequences Despite enormous economic investment, political support and claims to have revolutionised addiction medicine, neurobiological models are yet to produce a treatment for substance addiction This is partly, we claim, because neurobiology is unable to explain essential features of addiction and relapse that neurobehavioral models of addiction are better placed to investigate We show how addiction neuroscience turned to long-term memory to explain the chronicity of addiction and persistent relapses long after neurochemical traces have left the body The turn to memory may in time help to close the translational gap facing addiction medicine, but it is our view in this article that the primary value of memory theory lays in its potential to create new critical friendships between biological and social sciences that are attuned to the lived experience and suffering of stigmatised people The value of the memory turn may rest upon the capacity of these critical friendships to wean addiction science off its long-term dependence on disease concepts of human distress

Perceived Social Support Among Abstinent Individuals with Substance Use Disorder

Abstract: Substance use disorder is a major public health concern in India. Understanding social support among persons who were abstaining from substance use would help in promoting long-term abstinence. To examine perceived social support among abstinent individuals with substance use disorder.Cross-sectional study design was used. Sixty subjects who were attending follow-up service were selected consecutively from out-patient specialty clinic (Addiction Medicine), tertiary care teaching hospital, Bangalore. Persons with SUDs between the age of 18–60 years with minimum abstinence period of three months and above were included. Exploratory analysis such as descriptive statistics, spearmen correlation was used. The study was approved by Institute ethics committee.Mean age of the respondents was 39.6 (S.D ± 9.5) years. Majority (60%) do not have peer pressure, majority (60%) had diagnosis of alcohol dependence and 80% had past history of abstinence, 40% were maintaining abstinence from three to six months. Majority (60%) were never hospitalized. Mean score of perceived social support among persons who were abstaining 90 days and above were 61.48 (± 13.50) indicating high perceived social support. Perceived social support was higher among persons who were abstaining from substance use for three months and above.

Building Substance Use Disorder Management Capacity During COVID-19: Outcomes From a Tele-mentoring Program for Community-based Healthcare Professionals

Abstract: Objectives: The limited access to addiction services pre-COVID-19 and the increase in substance use disorder support required during COVID has led to a heightened need for virtual addictions care capacity building interventions. We describe the evaluation of Project Extension for Community Healthcare Outcomes (TM)-Ontario Addiction Medicine and Psychosocial Interventions (ECHO-AMPI), a Canadian virtual tele-mentoring program focused on building capacity in community-based addiction care during COVID-19. Methods: We used Moore's multi-level evaluation framework for continuing education. Participants rated their satisfaction on a five-point Likert scale. A pre-post 10-item scale was used to measure self-efficacy. Participants used a binary scale to self-report post-participation whether ECHO changed their practice. Participants also responded to an open-text question around how participation in ECHO has impacted challenges experienced during the pandemic. Results: Seventy-nine healthcare professionals from 62 organizations across Ontario participated in ECHO-AMPI. Mean satisfaction ratings were high (>4.27/5), and a 12% improvement in participants' addictions care mean self-efficacy scores was observed (P < 0.001). Post-ECHO participation, 77% of participants reported practice change. Analysis of open-text responses highlighted participants felt ECHO fostered an open and supportive community, improved knowledge and skills via the acquisition of new resources, enhanced participants' interaction with their clients, and reduced professional isolation. Conclusions: ECHO-AMPI demonstrated the ability to engage providers and build addictions care capacity during COVID-19, specifically by improving learning outcomes and supporting practice change. Our data also suggests that this virtual tele-mentoring model can provide a supportive community of practice for addictions care providers during COVID-19.

The Development and Implementation of a Hospitalist-Directed Addiction Medicine Consultation Service to Address a Treatment Gap

Abstract: Hospitalizations related to the consequences of substance use are rising yet most hospitalized patients with substance use disorder do not receive evidence-based addiction treatment. Opportunities to leverage the hospitalist workforce could close this treatment gap. To describe the development, implementation, and evaluation of a hospitalist-directed addiction consultation service (ACS) to provide in-hospital addiction treatment. Six hundred fifty–bed university hospital in Aurora, Colorado. Hospitalists completed buprenorphine waiver training, participated in a 13-part addiction lecture series, and completed a minimum of 40 hours of online addiction training. Hospitalists participated in shadow shifts with an addiction-trained physician. Dedicated addiction social workers developed relationships with local addiction treatment services. Physician-related metrics included education, training, and clinical time spent in addiction practice. Patient and encounter-related metrics included a description of ACS care provision. Eleven hospitalists completed an average of 95 hours of addiction-related didactics. Once addiction training was complete, hospitalists spent an average of 30 days over 12 months staffing a weekday ACS. Between October 2019 and November 2020, the ACS completed 1620 consultations on 1350 unique patients. Alcohol was the most common substance (n = 1279; 79%), followed by tobacco (979; 60.4%), methamphetamines/amphetamines (n = 494; 30.5%), and opioids (n = 400; 24.7%). Naltrexone was the most frequently prescribed medication (n = 350; 21.6%), followed by acamprosate (n = 93; 5.7%), and buprenorphine (n = 77, 4.8%). Trauma was a frequent discharge diagnoses (n = 1564; 96.5%). Leaving prior to treatment completion was commonly noted (n = 120, 7.4%). The ACS completed 47 in-hospital methadone enrollments. The hospitalist-directed ACS is a promising clinical initiative that could be implemented to expand hospital-based addiction treatment. Future research is needed to understand challenges to disseminating this model into other hospital settings, and to evaluate intended and unintended effects of broad implementation.

A Telemedicine Approach to Increase Treatment of Alcohol Use Disorder in Primary Care: A Pilot Feasibility Study.

Abstract: BACKGROUND AND AIMS Unhealthy drinking is a leading threat to health, yet few people with alcohol use disorder (AUD) receive treatment. This pilot tested the feasibility of addiction medicine video consultations in primary care for improving AUD medication adoption and specialty treatment initiation. METHODS Primary care providers (PCPs) received training and access to on-call addiction medicine consultations. Feasibility measures were training attendance, intention to use the service and/or AUD pharmacotherapy, and user feedback. Secondary outcomes were utilization, prescription and treatment initiation rates, and case reports. χ2 tests were used to compare prescription and treatment initiation rates for consult recipients and non-recipients. RESULTS Ninety-one PCPs (71.1%) attended a training, and 60 (65.9%) provided feedback. Of those, 37 (64.9%) mentioned pharmacotherapy and 41 (71.9%) intended to use the video consult service. Of 27 users, 19 provided feedback; 12 (63.1%) rated its value at 8 or above, on a scale of 1 to 10 (average 6.9). The most useful aspect was immediacy, and users wanted an easier workflow and increased consultant availability. Of 32 patients who received a consult, 11 (34.4%) were prescribed naltrexone, versus 43 (6.4%) of non-recipients (P < 0.0001); 11 (34.4%) initiated specialty treatment, versus 105 (19.7%) of non-recipients (P < 0.05). CONCLUSIONS PCP training attendance and feedback suggest that an addiction telemedicine consult service would be valuable to PCPs and might increase AUD medication uptake and specialty addiction treatment initiation. However, future research should include significant modifications to the piloted telemedicine model: robust staffing and simpler, more flexible methods for PCPs to obtain consults.

Involuntary Commitment for Substance Use: Addiction Care Professionals Must Reject Enabling Coercion and Patient Harm.

Abstract: Ethical and epidemiological concerns should mobilize addiction care providers to deploy their expertise and collective influence to challenge the use of state power to coerce people into treatment settings-especially when such settings often diverge from best clinical practices. Troublingly, with few notable exceptions, the voices of professional organizations on this issue have been largely lacking. This issue of the Journal includes a timely manuscript that sheds light on this resounding silence: "Civil Commitment for Substance Use Disorders: A National Survey of Addiction Medicine Physicians" by Jain et al. provides important and novel insights into the beliefs of physicians regarding civil commitment statutes. This study distributed a web-based survey to physician-members of the American Society of Addiction Medicine with questions gauging awareness of, attitudes toward, and experiences with civil commitment for individuals with substance use disorder. Surprisingly, the study found that the overwhelming majority of addiction medicine providers supported the application of civil commitment for substance use disorder-60.7% reported being in favor of its use whereas only 21.5% reported being opposed.

Neurocognitive Disorders in Substance Use Disorders

Abstract: Chronic use of different substances is associated with neural dysfunctions and related cognitive deficits. Neurocognitive disorders encompass reward, negative affect and control deficits underlying core addiction symptoms, and broader cognitive sequela affecting everyday functioning. In the first part of this chapter, we summarise the theoretical models posited to understand the nature and course of addiction-related cognitive deficits, with special emphasis on dual and tripartite models and recent international consensus. Then, we review the specific neurocognitive disorders associated with chronic use of different drugs, including alcohol, cannabis, opioids and stimulants, while acknowledging the role of premorbid cognitive alterations and polysubstance use. In the last part of the chapter, we analyse the neural dynamics underlying these deficits, including development-related changes underpinning the transition between recreational and chronic use and neuroplasticity-related changes that can be achieved via pharmacological enhancement, cognitive remediation and neuro-stimulation. We conclude by providing a critical view of the strengths and weaknesses of current frameworks and assessment and intervention approaches and a perspective of future horizons for neurocognitive research and clinical applications in addiction medicine.

A 5-Factor Framework for Assessing Tobacco Use Disorder.

Abstract: Cigarette use is the leading cause of preventable death in the United States. Despite the well documented dangers of smoking, nearly 20% of adults report regular use of tobacco. A majority desire to discontinue but the long-term cessation success rate remains near 4%. One challenge to reducing the prevalence of tobacco use is an incomplete understanding of the individual correlates that reinforce continued use. Evidence from research on nicotine and tobacco suggests that Tobacco Use Disorder is a complex, and multifactorial condition. Personality traits, comorbidities, habits and lifestyle, genetics, socioeconomic status, and mental and physical health all contribute to the risk for dependence and to the likelihood of quitting. This perspective review provides an overview of some common factors that contribute to liability risk for Tobacco Use Disorder and a framework for assessing individual tobacco users. The framework includes 5 areas that research suggests contribute to continued tobacco use: nicotine addiction, psychological influences, behavioral dependencies, neurobiological factors, and social reinforcement. Nicotine addiction includes drug-seeking behavior and the role of withdrawal avoidance. Psychological and emotional states contribute to a perceived reliance on tobacco. Behavioral dependence is reinforced by associative and non-associative learning mechanisms. Neurobiological factors include genetic variables, variations in neurotransmitters and receptors, pharmacogenetics, and interaction between psychiatric illnesses and nicotine use and dependence. Finally, social reinforcement of smoking behavior is explained by a network phenomenon and consistent visual cues to smoke. A comprehensive assessment of individual tobacco users will help better determine appropriate treatment options to achieve improved efficacy and outcomes.

Case report: rapid inpatient methadone titration during pregnancy

Abstract: Rates of opioid use disorder and opioid overdose during pregnancy and in the postpartum period are increasing. While methadone remains a cornerstone of treatment for women with opioid use disorder ...

Addiction Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures.

Abstract: Introduction The need for innovative approaches to address the opioid epidemic in the United States is widely recognized. Many challenges exist to addressing this epidemic, including the obstacles outpatient substance use treatment practices face in implementing measurement-based care (MBC), quality measurement systems, and evidence-based treatments. Also, there are insufficient opportunities for clinicians in these settings to participate in research, resulting in diminished translation of research findings into community-based practice. To address these challenges, the Addiction Medicine Practice-Based Research Network (AMNet) was developed to facilitate the uptake of MBC in outpatient practices via implementation of patient-reported assessments and quality of care performance measures to improve patient outcomes. This network will offer clinicians in outpatient settings (not incuding opioid treatment programs [OTPs]) the opportunity to participate in future substance use disorder treatment research studies. Methods A key step in the development of AMNet was the selection of substance use-specific assessment tools and quality of care performance measures for incorporation into the American Psychiatric Association's mental health patient registry, PsychPRO. A scoping review and multi-step consensus-based process were used to identify, review and select candidate assessment tools and quality of care performance measures for opioid use disorders (OUD) and substance use disorders (SUD). Results Following a consensus-based methodology, 12 standardized assessment tools and 3 quality of care performance measures for OUD and SUD were selected to help facilitate the implementation of MBC and quality improvement for AMNet participants. These tools were further categorized as core and optional. Conclusion By offering a collection of carefully vetted assessment tools and quality measures through PsychPRO, AMNet will help participating clinicians with the systematic uptake of MBC and delivery of evidence-based treatment for patients with SUD. Also, AMNet will act as a centralized repository of data collected from patients and clinicians in non-OTP outpatient addiction medicine practices and serve as a platform for opioid treatment research.

Physician blame and vulnerability: novel predictors of physician willingness to work with patients who misuse opioids.

Abstract: Successfully combating the opioid crisis requires patients who misuse opioids to have access to affirming and effective health care. However, there is a shortage of physicians who are willing to work with these patients. We investigated novel predictors of what might be contributing to physicians’ unwillingness to engage with this patient population to better identify and direct interventions to improve physician attitudes. 333 physicians who were board certified in the state of Ohio completed a survey about their willingness to work with patients who misuse opioids. The hypothesized relationships between the proposed predictors and willingness to work with this patient population were tested using multivariate regression, supplemented with qualitative analysis of open-text responses to questions about the causes of addiction. Perceptions of personal invulnerability to opioid misuse and addiction, opioid misuse and addiction controllability, and health care provider blame for the opioid crisis were negatively associated with physician willingness to work with patients who misuse opioids after controlling for known predictors of physician bias toward patients with substance use disorders. Physicians working in family and internal medicine, addiction medicine, and emergency medicine were also more willing to work with this patient population. Distancing oneself and health care professionals from opioid misuse and placing blame on those who misuse are negatively associated with treatment willingness. Interventions to improve physician willingness to work with patients who misuse opioids can target these beliefs as a way to improve physician attitudes and provide patients with needed health care resources.