This Week in Addiction Medicine from 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