Lead Story: Association of Medication Treatment for Opioid Use Disorder With Suicide Mortality

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Association of Medication Treatment for Opioid Use Disorder With Suicide Mortality

The American Journal of Psychiatry 

This study evaluated whether medications for opioid use disorders (MOUD) are associated with reduced risk of suicide mortality and compared different agents. Data were collected for 61,633 veterans (93% male) receiving MOUD. Approximately half received buprenorphine and a quarter received methadone or naltrexone (oral or extended-release).  The hazard ratio (HR) for suicide mortality while on MOUD was 0.45 and for all-cause mortality, it was 0.34. Stopping MOUD increased the risk for suicide (HR = 1.47) and all-cause mortality (HR = 1.14). Buprenorphine reduced suicide mortality (HR = 0.34) whereas naltrexone did not (HR = 1.28). Buprenorphine reduced all-cause mortality (HR = 0.27) to a greater extent than naltrexone (HR = 0.64), while results with methadone were less clear. Overall, MOUD produced dramatic reductions in both suicide and all-cause mortality with the effect most pronounced for buprenorphine. Naltrexone, however, did not reduce suicide mortality.   

 

Research and Science 

Fetal Exposure to Cannabis and Childhood Metabolic Outcomes: The Healthy Start Study 

The Journal of Clinical Endocrinology & Metabolism

This study investigated whether fetal exposure to cannabis is associated with increased adiposity and markers of impaired glucose homeostasis in early childhood. Approximately 15% of mothers had detectable levels of any cannabinoid at ~27 weeks’ gestation, indicating fetal exposure to cannabis. Fetal exposure to cannabis was associated with increased adiposity and fasting glucose in early childhood. This study further supports discouraging women from using any cannabis while pregnant or breastfeeding to minimize adverse health effects on the offspring.

 

Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021 

Drug and Alcohol Dependence

Fentanyl continues to be a leading cause of overdose in the United States and is increasingly found in counterfeit prescription pills. This study examines trends in pills containing fentanyl using the national seizure data from High Intensity Drug Trafficking Areas between January 2018 and December 2021. There was a significant increase in both fentanyl-containing powder seizures (424 to 1539) and pill seizures (68 to 635) during the study period. In addition, the proportion of seizures that were pills increased (13.8% to 29.2%) and the number of pills seized increased (42,202 to 2,089,186). While the presence of fentanyl in heroin supply is more widely known, its presence in pills poses a potential risk that is not as widely disseminated, resulting in the need for public education. 

 

Beliefs and Characteristics Associated With Believing Nicotine Causes Cancer: A Descriptive Analysis to Inform Corrective Message Content and Priority Audiences

Nicotine and Tobacco Research

In this study, authors examine cigarette smokers’ perceptions about harm from tobacco, specifically nicotine as the source of harm. The authors found that a significant proportion of smokers (61.2%) believed that nicotine was the source of cancer risk or were not sure. This belief was more common among non-Hispanic Black and Hispanic smokers as well as those with low incomes. Smokers with high school or higher education were less likely to believe nicotine was the source of the risk. In addition, those who had used a non-combustible tobacco product, including electronic cigarettes, were less likely to have this perception. The misperception about the risk of nicotine may impact smokers’ behavior, and switching to less harmful products and education is needed to correct this commonly held belief.  

 

Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults

JAMA Network Open

This randomized clinical trial involving 186 participants examined the risks and benefits of obtaining a medical marijuana card for adults who seek medical marijuana for pain, insomnia, and anxiety or depressive symptoms. Immediate acquisition of a medical marijuana card increased the incidence and severity of cannabis use disorder (CUD) and resulted in no significant improvement in pain, anxiety, or depressive symptoms, but improved self-reported sleep quality. Findings suggest the need for further investigation into the benefits of medical marijuana card ownership for insomnia symptoms and the risk of CUD, particularly for those with anxiety or depressive symptoms.

 

Learn More

Burst Suppression Electroencephalography (EEG) Pattern with Coma and Loss of Brain Stem Reflexes Following a Baclofen Overdose with Subsequent Full Recovery

 American Journal of Case Reports

Baclofen toxicity can present both clinically and with EEG abnormalities consistent with anoxic brain injury, suggesting an inevitable progression to brain death. This is a case report of a middle-aged woman found unresponsive who presented with apnea, loss of rudimentary neurologic findings on physical exam, burst suppression EEG findings, and a prolonged comatose state for nearly 48 h, followed by rapid resolution of symptoms secondary to a supratherapeutic baclofen ingestion. When provided with appropriate supportive care and prolonged observation, improvement with full neurologic recovery is often seen despite the initial grim clinical picture.

 

Against Our Instincts: Decriminalization of Buprenorphine

Journal of the American Board of Family Medicine

In this commentary the authors make a case for the decriminalization of the possession of buprenorphine. The authors cite the dramatic reduction in mortality (by 2/3 in one meta-analysis) with buprenorphine treatment. According to data from Tennessee, buprenorphine has little risk of overdose when used alone. A meta-analysis indicated that diverted buprenorphine was used for therapeutic rather than recreational purposes. Many have difficulty accessing buprenorphine due to a lack of providers and economic barriers, and the authors note that when a Vermont county decided not to prosecute possession of buprenorphine (along with other measures to increase access) the overdose rate reduced by 50% while increasing in the rest of the state. The authors conclude that the benefits of decriminalizing buprenorphine possession outweigh the risks.