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Lead Story 

Drug and Alcohol Dependence

Very low nicotine cigarettes (VLNC, 0.4 mg nicotine/g tobacco) have been shown to reduce smoking behavior when compared to normal nicotine cigarettes (NNC,17 mg nicotine/g tobacco). Participants (n=208) were randomly assigned to 4 experimental groups, immediate vs gradual (over 5 weeks) transition to VLNC, and standard counseling vs facilitated extinction counseling (weekly for 5 weeks). Facilitated extinction involved participants smoking only in relevant contexts (eg, places, affects, triggers). The immediate nicotine reduction group reported less smoking satisfaction and lower completion rates (72% immediate reduction vs 88% gradual reduction, p=.02). Abstinence (biochemically verified) at 2 months post study was 29%. There were no significant differences between the 4 study groups. VLNC were beneficial in smoking cessation. 

Research and Science

Alcohol, Clinical and Experimental Research

Studies have demonstrated the effectiveness of contingency management (CM) for alcohol use disorder (AUD), however there is limited evidence for unhealthy alcohol use (UAU). This systematic review and meta-analysis assessed the evidence for CM in UAU. Of the studies meeting inclusion criteria (n=29), 21 were randomized controlled trials. Weekly contingency reward values ranged from $12.80 to $116 with 4 studies using rewards other than money. Studies measuring alcohol-free days (n=5) showed a significant increase with CM (OR 4.0, p=.01). Studies measuring negative alcohol samples also showed significant increases for those with UAU and not AUD (6 studies, OR 3.6, p<.0001) as well as those with AUD (3 studies, OR 2.6, p=.04). Some studies also showed decreases in cigarette and stimulant use; those measuring cannabis use found no significant effect. In individuals with UAU, CM reduces alcohol use. 

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The American Journal of Psychiatry 

Among individuals who engaged in regular cannabis use and heavy episodic drinking, smoking cannabis acutely reduced subsequent alcohol consumption. In a double-blind crossover randomized controlled clinical trial with 138 healthy adults, cannabis containing 3.1% and 7.2% Δ9-tetrahydrocannabinol (THC), compared to placebo cannabis, acutely decreased alcohol consumption on an Alcohol Choice Task. While cannabis smoking did not significantly change cue-induced alcohol craving, 7.2% THC dose significantly reduced alcohol urge, relative to placebo, immediately post smoking. 

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JAMA Health Forum

This research letter used a 100% dataset from the Centers for Medicare and Medicaid Services to evaluate the number of patients receiving methadone or buprenorphine for opioid use disorder among adult Medicaid enrollees from 1999 to 2020. Data represented Medicaid enrollees in all 50 states, Washington DC, Puerto Rico, and the Virgin Islands; dual Medicare and Medicaid enrollees were excluded. There were modest increases in methadone and buprenorphine use from 1999 to 2010. From 2010 to 2020, use of both methadone and buprenorphine increased, with buprenorphine use increasing substantially more than methadone use. Also from 2010 to 2020, use of methadone for pain declined. 

The American Journal of Psychiatry 

MDMA has been proposed to assist with therapy for posttraumatic stress disorder (PTSD). Two phase 3 trials have been conducted with MDMA-assisted therapy, but the FDA rejected the New Drug Application and requested additional details. While they did not provide guidance for future studies, the authors of this commentary discuss some of the potential issues with prior trials that used inner-directed therapy (IDT). The authors do note the promise of MDMA-assisted therapy and support additional studies with MDMA-assisted IDT. They also support additional MDMA-assisted therapy trials using alternative therapy modalities to better understand the efficacy of such treatment.  

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JAMA Network Open 

While snus and smokeless tobacco do cause harm, they are less harmful than cigarettes. Researchers used data from the Population Assessment of Tobacco and Health Study to assess if US adults were aware of this difference in harm.  Overall, only a small proportion of the population was aware that snus (7.8%) and smokeless tobacco (7.5%) are less harmful than cigarettes. Among those who used snus or smokeless tobacco, a larger proportion noted these modalities are of less harm (30.1% and 28.9%). The authors note that given the perception that snus and smokeless tobacco cause equal harm to cigarettes, those who use these products may be more likely to initiate smoking, and those who smoke may not view these products as less harmful alternatives.