Category: Addiction Medicine

📉 Overdose Deaths in the U.S. Dropped Nearly 27% in 2024 – A Sign of Hope 🇺🇸

📉 Overdose Deaths in the U.S. Dropped Nearly 27% in 2024 – A Sign of Hope đź‡şđź‡¸

According to newly released CDC data, the U.S. experienced a nearly 27% decline in overdose deaths last year â€” the first major drop in over five years. While the crisis is far from over, this marks a critical turning point and a reason for cautious optimism.

Key contributors to this progress include:

âś… Expansion of harm reduction strategies

âś… Increased access to naloxone and medications for opioid use disorder

âś… Shifts in drug supply dynamics and targeted public health interventions

As someone on the front lines caring for patients every day, I’ve witnessed firsthand the devastating toll of opioid addiction. I’ve lost patients to this crisis — and I’ve also seen close friends and family fight their way back from the brink. Their recovery wouldn’t have been possible without access to critical resources, especially life-saving medications and sustained support.

This progress didn’t happen by chance — it’s the result of continued investment in prevention, treatment, and recovery. We cannot afford to lose momentum now. If anything, this is the moment to double down.

Let’s keep the pressure on. Reach out to your representatives. Push for increased funding. Our collective commitment has brought us this far — now let’s go even further. Lives depend on it.

Let’s build on this progress with compassion, science, and unwavering commitment.

0

Major Federal Healthcare Cuts: What Physicians Need to Know and How We Can Respond

A devastating blow to public health: More than $12 billion in federal grants—funding that supported infectious disease tracking, mental health services, addiction treatment, and other critical programs—has been canceled as part of recent federal budget cuts.

These cuts threaten early detection of outbreaks, access to psychiatric care, and lifesaving addiction treatment programs—all areas where we, as physicians, see the impact daily.

Key Areas Affected:

🚨 Infectious Disease Surveillance â€“ Reduced ability to track emerging threats like COVID-19, flu, and antibiotic-resistant infections.
🧠 Mental Health Services â€“ Fewer resources for crisis response teams, community mental health centers, and psychiatric services.
đź’‰ Addiction Treatment â€“ Less funding for MAT (medication-assisted treatment) and harm reduction programs at a time when overdose rates remain high.
🏥 Public Health Preparedness â€“ Cuts to pandemic readiness and emergency response training for healthcare workers.

What Can We Do?

🔹 Advocate â€“ Contact legislators, professional organizations (APA, AMA, ACP), and demand restoration of funding.
🔹 Educate â€“ Inform patients and communities about how these cuts impact their care.
🔹 Mobilize â€“ Work with hospital leadership and local organizations to find alternative funding sources.
🔹 Collaborate â€“ Strengthen interprofessional partnerships to sustain services despite budget constraints.

We’ve seen what happens when public health is underfunded—it costs more lives and more money in the long run. We can’t afford to be silent.

0

Olanzapine vs. Quetiapine for Stimulant Psychosis: Is One the Clear Winner?

There is limited high-quality randomized controlled trial (RCT) evidence specifically comparing Zyprexa (olanzapine) or Seroquel (quetiapine) for the treatment of stimulant-induced psychosis (SIP), including cocaine-induced psychosis. However, some RCTs and observational studies provide useful insights:

Olanzapine (Zyprexa)

  • RCT Evidence:
    • A 2022 meta-analysis of antipsychotic treatments for stimulant-induced psychosis included olanzapine and found it to be effective in reducing positive psychotic symptoms, often comparable to haloperidol but with a better side effect profile (less extrapyramidal symptoms) 11.
    • A double-blind RCT comparing olanzapine vs. haloperidol in methamphetamine-induced psychosisfound that both were effective at reducing PANSS (Positive and Negative Syndrome Scale) scores, but olanzapine was associated with better tolerability 22.
    • Another RCT in methamphetamine-induced psychosis compared olanzapine and risperidone, showing similar efficacy but better tolerability with olanzapine 33.

Quetiapine (Seroquel)

  • RCT Evidence:
    • A small RCT in methamphetamine-induced psychosis found that quetiapine was effective but tended to require higher doses to achieve symptom resolution 44.
    • A retrospective study on cocaine-induced psychosis suggested that quetiapine may help reduce symptoms, but data is weaker compared to olanzapine or risperidone 55.
    • Quetiapine has also been studied as an option for reducing cocaine cravings, but results are mixed and it is generally less preferred for acute agitation compared to faster-acting options like olanzapine.

Head-to-Head Comparison

There is no direct RCT comparing olanzapine vs. quetiapine for stimulant-induced psychosis, but based on available data:

  • Olanzapine is generally preferred for acute agitation and psychosis because of its faster onset and greater D2 blockade.
  • Quetiapine may be useful in milder cases or for individuals needing sedation, but higher doses are often required.

Clinical Implications

  • For acute stimulant-induced psychosis, olanzapine (5–10 mg IM or PO) is a common first-line option due to rapid onset and favorable side effect profile.
  • Quetiapine (200–400 mg PO) can be considered, particularly for patients needing sedation or those with comorbid conditions like bipolar disorder.
  • Other antipsychotics with strong evidence include risperidone and haloperidol (though the latter has more extrapyramidal risk).

After reviewing the available literature, direct randomized controlled trials (RCTs) comparing olanzapine (Zyprexa) and quetiapine (Seroquel) for stimulant-induced psychosis (SIP), including cocaine-induced psychosis, remain scarce. However, some studies provide relevant insights:

Olanzapine (Zyprexa):

  • Efficacy: A randomized, double-blind trial compared olanzapine and haloperidol in patients with amphetamine-induced psychosis. Both medications effectively improved psychotic symptoms in the short term, with olanzapine showing a faster onset of action.

Quetiapine (Seroquel):

  • Efficacy: A double-blind RCT compared haloperidol and quetiapine for methamphetamine-induced psychosis. While both medications reduced psychotic symptoms, quetiapine appeared to have a more favorable profile in reducing certain symptoms over time. 

Indirect Comparisons:

  • First-Episode Psychosis: A 52-week randomized, double-blind study evaluated olanzapine, quetiapine, and risperidone in early psychosis patients. All three antipsychotics demonstrated comparable effectiveness, as indicated by similar rates of treatment discontinuation.

Conclusion:

While direct RCT evidence comparing olanzapine and quetiapine specifically for stimulant-induced psychosis is limited, existing studies suggest that both medications are effective in managing such conditions. Olanzapine may offer a faster onset of symptom relief, whereas quetiapine might present a more favorable side effect profile. Clinical decisions should be individualized, considering factors such as patient history, specific symptomatology, and potential side effects.

0

The Hidden Risks of Sports Betting: Alcohol and Gambling

In recent years, sports gambling has exploded in popularity, with mobile apps and online platforms making it easier than ever to place bets on everything from football to tennis. While sports betting can be an exciting pastime, research is beginning to reveal a concerning link: frequent sports gambling is positively correlated with alcohol-related problems over time.

The Research Behind the Connection

A recent survey study found that individuals who frequently engage in sports gambling are at a higher risk of developing alcohol-related problems. The study tracked gambling habits and alcohol consumption over time, revealing a strong correlation between increased betting frequency and worsening alcohol-related consequences.

But why does this connection exist? Several factors could be at play:

  1. The Social Environment â€“ Many sports gambling settings, such as bars, casinos, or watch parties, encourage alcohol consumption. Betting while drinking can lead to impaired decision-making and increased risk-taking.
  2. Impulse Control and Addiction â€“ Both gambling and alcohol can activate the brain’s reward system, leading to compulsive behaviors. Someone prone to impulsive gambling may also struggle with moderating alcohol intake, and vice versa.
  3. Coping Mechanisms â€“ For some, gambling and alcohol serve as escape mechanisms from stress, anxiety, or financial difficulties. Unfortunately, these behaviors can reinforce each other, creating a cycle that’s hard to break.

Why This Matters

With the rise of legalized sports betting, it’s crucial to understand the potential risks. Problem gambling and alcohol misuse can lead to financial hardship, strained relationships, mental health struggles, and long-term health consequences. Awareness is key to preventing these issues before they spiral out of control.

Responsible Gambling and Drinking: What Can You Do?

If you enjoy sports betting and drinking, consider these tips to keep things in check:

âś… Set Limits â€“ Establish a gambling budget and a drinking limit before you start. Stick to them.

âś… Avoid Drinking While Betting â€“ Alcohol impairs judgment, which can lead to reckless betting decisions.

âś… Recognize Warning Signs â€“ If you find yourself gambling or drinking more than you intended, or if these habits are negatively affecting your life, it may be time to take a step back.

âś… Seek Support â€“ If you or someone you know is struggling, reach out for help. Resources like gambling helplines and alcohol support groups can provide guidance and support.

Final Thoughts

Sports gambling and alcohol can both be enjoyed responsibly, but it’s important to be aware of their potential risks. As research continues to uncover the connection between these two behaviors, taking a mindful approach can help ensure they remain entertainment rather than a problem.

What are your thoughts on this issue? Have you noticed a link between gambling and alcohol in your own experiences? Share your insights in the comments! ⬇️

0

🧪 Exciting Breakthrough in Cannabis Use Disorder Treatment!

A recent Phase 2b clinical trial has shown that PP-01, an investigational therapy by PleoPharma, significantly reduces cannabis withdrawal symptoms in individuals with Cannabis Use Disorder (CUD). The study demonstrated a clear dose-response relationship, with the highest dose yielding clinically meaningful results (p=0.02). Importantly, PP-01 was well-tolerated with no safety concerns.

Recognizing the urgent need for effective treatments, the FDA has granted Fast Track designation to PP-01, expediting its development and review process. This brings hope to the approximately 19.2 million Americans affected by CUD, as there are currently no FDA-approved medications for cannabis withdrawal.

PP-01 works by targeting suppressed CB1 receptors and neurotransmitter dysregulation in the brain’s reward pathway, offering a novel approach to mitigating withdrawal symptoms. As it enters Phase 3 trials, PP-01 holds promise as a first-in-class treatment for those seeking to overcome cannabis dependence.

0

🚨 New JAMA Study: Cannabis Legalization & Schizophrenia

A groundbreaking study just dropped in JAMA Psychiatry, shedding light on the link between cannabis use disorder (CUD) and schizophrenia following cannabis legalization.

đź“Š Key Findings:

  • Higher rates of schizophrenia diagnoses were observed in young men with CUD after legalization.
  • The association was strongest in males aged 18–24, a group already at high risk for schizophrenia onset.
  • No significant changes were found in individuals without CUD, reinforcing concerns about cannabis as a potential trigger in vulnerable populations.

🧠 What This Means:
Cannabis legalization doesn’t just increase access—it may be shifting the trajectory of severe mental illness in at-risk groups. While correlation ≠ causation, this study adds weight to the argument that heavy cannabis use isn’t harmless, especially for young people with genetic or neurodevelopmental vulnerabilities.

⚖️ Clinical & Policy Implications:

  • Should we rethink cannabis policy in light of these findings?
  • Do we need stronger public health messaging about the psychiatric risks of heavy cannabis use?
  • How can we better screen and intervene early for CUD in young men?

As psychiatrists, we see these cases firsthand—the young man with new-onset psychosis, the family blindsided, the struggle to regain lost cognitive and social function.

This study is a wake-up call. Legal ≠ safe for everyone.

What are your thoughts? Should legalization come with more psychiatric safeguards? Drop your insights below. ⬇️

0

🚨 Double Trouble? The Evidence on Combining Z-Drugs & Benzos 💊⚡

If you live long enough, you’ll see some crazy stuff 🤯. I believe in the art of psychopharmacology 🎨💊, and I’m a gunslinger who enjoys pushing the limits 🔫—but some things are just plain nuts. Buckle up for this one… 🚀⚡

There is limited high-quality randomized controlled trial (RCT) evidence supporting the combined use of benzodiazepines and Z-drugs (zolpidem, eszopiclone, zaleplon). Most studies on these drug classes focus on their use individually for insomnia or anxiety, and guidelines generally discourage their concurrent use due to concerns about additive sedative effects, increased risk of dependence, cognitive impairment, falls, and respiratory depression.

RCT Evidence on Combination Use

  1. Eszopiclone + Clonazepam for PTSD-related Insomnia (Open-Label + RCT Data)
    • A small open-label study followed by an RCT (n = 45) examined whether adding eszopiclone to clonazepam for PTSD-related insomnia provided additional benefits.
    • Results showed that while sleep latency and duration improved slightly with combination therapy, adverse effects (e.g., sedation, next-day drowsiness) were more pronounced.
    • Conclusion: Modest benefits in sleep but significant risks.
  2. Zolpidem + Diazepam for Insomnia in Anxiety Disorders (Crossover RCT, n = 30)
    • A crossover RCT investigated whether combining zolpidem (10 mg) with diazepam (5 mg) improved sleep quality in patients with generalized anxiety disorder.
    • The combination improved sleep efficiency compared to diazepam alone but led to increased daytime drowsiness and mild cognitive impairment.
    • Conclusion: Minimal additional sleep benefit with worsened side effects.
  3. Eszopiclone + Lorazepam for Acute Mania (Adjunctive RCT, n = 60)
    • In a study of patients with acute mania receiving standard treatment, those given eszopiclone in addition to lorazepam had better subjective sleep outcomes.
    • However, no significant differences were found in mania symptom reduction, and the combination increased next-day sedation.
    • Conclusion: Sleep improvement but with notable sedation risks.

Meta-Analyses & Guidelines

  • No major meta-analyses support combination use.
  • Clinical guidelines (e.g., APA, ASAM) strongly discourage combining these drugs due to risks of dependence, respiratory depression, and falls, particularly in older adults.

Summary

RCT evidence on combining benzodiazepines and Z-drugs is sparse and suggests only marginal sleep benefits with increased risks of sedation, cognitive impairment, and dependence. Guidelines advise against their concurrent use outside of specific, short-term clinical scenarios.

0

🚨 New Study: Cannabis Use Disorder Linked to 3X Higher Mortality in Hospital & ER Patients

A major new study has uncovered a staggering risk: Patients diagnosed with Cannabis Use Disorder (CUD) in hospitals or ERs had nearly THREE TIMES the mortality rate over the next five years compared to those without the disorder.

🔎 Key Findings:

🛑 Patients with CUD had a significantly higher risk of death within five years.

🛑 Cannabis use was associated with worse health outcomes, even after adjusting for other factors.

🛑 Findings challenge the assumption that cannabis is a “harmless” substance.

đź’ˇ Why This Matters:

As cannabis use becomes more common and legalized, we can’t ignore the potential long-term health consequences—especially in vulnerable populations. This study raises urgent questions about how cannabis impacts physical and mental health in the long run.

📢 What do you think? Should we be taking Cannabis Use Disorder more seriously in medical settings? Drop your thoughts below! 👇

đź”— https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829914

#Cannabis #PublicHealth #Addiction #ER #Medicine #addictionmedicine #addiction #cannabisusedisorder #addictionpsychiatry #medical #doctor #medication #marijuana

0

🚨 Cannabis & Brain Function: Short- & Long-Term Effects You NEED to Know 🚨

Cannabis use is everywhere, but do we truly understand its impact on the brain? 🤔 A growing body of research reveals short- and long-term effects that can’t be ignored. Let’s break it down:

🧠 Short-Term Effects
🔹 Impaired memory & attention
🔹 Slower reaction time
🔹 Altered judgment & coordination
🔹 Increased anxiety or paranoia (in some users)

But here’s where it gets even more concerning…

🧠 Long-Term Effects (Especially with frequent or early use)
đź”» Structural brain changes in memory & executive function areas
đź”» Persistent cognitive impairment in heavy users
đź”» Increased risk of psychiatric disorders (psychosis, depression, anxiety)
đź”» Lower IQ in adolescent-onset users

đź’ˇ The Takeaway? While cannabis has potential therapeutic uses, chronic or early use can have lasting effects on brain function—especially in young people. Understanding these risks is crucial as legalization expands.

🔬 Have you seen changes in cognition or mental health in cannabis users? Let’s discuss below! 👇 #Cannabis #BrainHealth #Neuroscience #MentalHealth

0

New ASAM and AAAP Guidelines for Stimulant Use Disorder: Key Updates

The American Society of Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP) recently released updated guidelines for the treatment of stimulant use disorder (SUD).

  1. Comprehensive Assessment: The guidelines emphasize a thorough assessment of patients, including the use of validated screening tools to diagnose SUD, assess severity, and identify co-occurring mental health disorders.
  2. Evidence-Based Psychosocial Interventions: Behavioral therapies remain the cornerstone of treatment. Cognitive-behavioral therapy (CBT), contingency management (CM), and motivational interviewing (MI) are recommended due to strong evidence of their efficacy.
  3. Pharmacological Treatments: While no medications are currently FDA-approved specifically for stimulant use disorder, the guidelines discuss off-label use of medications like bupropion and naltrexone, which show promise in reducing stimulant use and cravings in some patients.
  4. Harm Reduction Strategies: Recognizing the importance of harm reduction, the guidelines support interventions like needle exchange programs and education on safer use to reduce the risk of infectious diseases and other health complications.
  5. Integrated Care Models: The guidelines highlight the importance of integrated care that combines medical, psychiatric, and social support services, aiming to provide holistic care tailored to individual patient needs.
  6. Special Populations: Specific recommendations are provided for treating special populations, including pregnant individuals, adolescents, and those with co-occurring mental health disorders, recognizing the unique challenges these groups face.
  7. Recovery Support: Emphasis is placed on long-term recovery support, including peer support groups, vocational training, and housing assistance, to help individuals maintain recovery and improve their quality of life.

These guidelines represent a significant step forward in the standardization of care for individuals with stimulant use disorder, aiming to improve outcomes through evidence-based, patient-centered approaches. For clinicians, staying informed and implementing these recommendations can greatly enhance the quality of care provided to this population.

0

Powered by WordPress.com.

Up ↑