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This Week in the ASAM Weekly

Addressing the harms of tobacco (and its derivatives) continues to be tricky. The FDA is considering a standard that lowers nicotine levels in cigarettes essentially rendering them non-addictive, but a perspective from the explains how such a maneuver could be easily countered. Big tobacco can re-engineer cigarettes while still threatening public health through a number of different tactics such as additives, bronchodilation, enzymatic inhibition, chemical enhancers etc.

With that in mind, we have learned to be suspicious of the tobacco industry (and its derivatives). Annvited editorial in  explains how insufficient policies at a professional society allowed for industry influence in its journal- which the authors say enable racist industry tactics to persist and evolve. Similarly, a recent study found that a majority of influencer posts about e-cigarettes are purely promotional- which studies have shown lead to increased vaping among youth- despite the fact that the FDA and even Instagram have explicit rules against this ().

Another challenge of tobacco use is that it is often a confounding factor for cannabis use, especially when studying neonatal outcomes. Now, a large cohort study found that combined cannabis and tobacco use actually have adverse synergistic effects on neonatal morbidity and mortality when compared to either substance alone ().

One thing we know for sure about tobacco is that for some people it is so easy to quit, . For these non-abstainers, maybe we should think of giving higher doses of pharmacotherapies ()?

In fact, we should be re-thinking how we approach all non-abstainers within substance use treatment settings and that’s why ASAM drafted the . It’s open to public comment for only a few more weeks so take a look and tell us your thoughts.

(If you’re looking for more information on tobacco cessation, check out ASAM’s Clinical Guidance – .)

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM, Jack Woodside, MD, John A. Fromson, MD

ASAM Clinical Considerations for Engagement and Retention of Non-Abstinent Patients in Substance Use Treatment

Beginning today through June 3rd, ASAM has made available for public comment a draft of its Clinical Considerations for Engagement and Retention of Non-Abstinent Patients in Substance Use Treatment document.

Lead Story

International Journal of Drug Policy

An association between cannabis use and violent behavior has previously been reported, so the authors used the 2015-2019 National Survey on Drug Use and Health to better explore this association. In adjusted models, the authors found an increased prevalence of violent behavior among males reporting daily cannabis use with and without cannabis use disorder (CUD) versus no cannabis use. However, there was no increase among males reporting non-daily cannabis use with or without CUD. Researchers found an increase in violent behavior among females reporting non-daily use with or without CUD and daily use with or without CUD. While additional research is needed to better understand this relationship and the sex differences, these findings support the importance of early screening and treatment for CUD.

ASAM Clinical Algorithm Subcommittee 
CALL FOR APPLICATIONS!

The ASAM Clinical Algorithm Subcommittee is looking for members to collaborate on refining the 4^th Edition clinical algorithms for ASAM Criteria-based assessment tools! Click the link below to learn more and apply.

Applications due May 31, 2024.