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.

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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.

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Nicotine e-cigarettes for cigarette smoking cessation: Recommendations to US-based clinicians

Journal of the American Medical Association

This Special Communication summarizes the evidence on the use of e-cigarettes for smoking cessation and provides recommendations for clinicians on how to engage in conversations with adult patients who currently smoke cigarettes. Specifically, advice is provided on (1) integration of e-cigarettes into patient-centered shared decision-making conversations on the risks and benefits of various pharmacologic smoking cessation treatments; and (2) practical guidance on the use of e-cigarettes for smoking cessation. The authors include one overarching recommendation: integrate e-cigarettes into conversations on the risks and benefits of all evidence-based pharmacologic treatments for smoking cessation. In support of this recommendation, specific guidance is provided regarding how to discuss potential misperceptions and suggested questions are offered to guide patient conversations. Evidence-based best practices are also provided for using e-cigarettes to quit smoking.

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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.

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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.

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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.

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Oral Semaglutide for Alcohol Use Disorder: A Randomized Clinical Trial

The American Journal of Psychiatry

Accumulating preclinical and observational evidence suggests that glucagon-like peptide-1 receptor agonists, including semaglutide, reduce alcohol consumption. This phase 2 double-blind, randomized, parallel-arm trial evaluated the effects of oral semaglutide on alcohol craving and consumption among treatment-seeking adults with alcohol use disorder (AUD). It found that semaglutide did not significantly reduce laboratory-assessed craving or drinks per day compared with placebo but significantly reduced heavy drinking days. Semaglutide also significantly reduced drinks per drinking day, naturalistic alcohol craving, and cannabis use days. Semaglutide reduced alcohol-related consequences at a significantly greater rate than placebo. Significantly more participants in the semaglutide group than the placebo group reduced their risk drinking level by one or more levels. These findings confirm previous results among non–treatment seekers with less severe AUD and suggest that continued development of semaglutide for AUD is warranted.

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Reflections on the preparation, implementation, and sustainability of a virtual SUD clinic: A public health response to the opioid epidemic

Journal of Substance Use and Addiction Treatment

This is an exploratory case study to identify barriers, facilitators, and implementation needs during the phases of implementation of a virtual SUD clinic offering low-barrier MOUD across the state of Texas. From January 2022 to September 2023, researchers conducted 10 individual and 11 group periodic reflections with 16 individuals (including clinic leadership, operation staff, and providers) to evaluate implementation activities, clinic processes, and events during the rollout of the virtual clinic. In the preparation phase, participants emphasized the importance of strong leadership, effective workforce and technology infrastructure, staff training, and mission alignment. During implementation, participants highlighted the need for strong interprofessional communication, continuous reflection and evaluation, and medication supply chain management, as well as the challenge of workforce turnover. In the sustainment phase, participants identified a need for diversified funding and intentional growth.

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