John Moritz, DO, FACP, FASAM

01/19/2023

I envision a different Sarasota one day. A city that includes a community of collaborative health care facilities and partners vigorously engaged in advancing the care for those suffering from substance use and mental health disorders.

12/17/2020

https://pubs.niaaa.nih.gov/publications/surveillance-covid-19/COVSALES.htm

12/17/2020

The latest National Survey on Drug Use and Health: 2019 (NSDUH) has been released by SAMHSA this past September. This report is published annually and provides a snapshot of substance use and Mental Health issues in the U.S. and helps to inform public policy.
Some highlights:

Past month alcohol use and past year alcohol use disorder remained stable in all age groups during 2018-2019
Alcohol use and Alcohol Use Disorder declined significantly in young adults from 2016 to 2019.

Conversely Ma*****na use in the 12 y/o and older cohort has significantly increased to 17.5% (48.2M) from 15.9% in 2018.

Encouraging indicators for our Opioid misuse in the U.S. include a modest decline overall for each opioid category except prescribed fentanyl (no change).
• 10.1 M (3.7% U.S. pop) suffer from OUD
• 9.7M or 96.6% of those with OUD misuse prescribed pain relievers. This breaks down to 5.1M misusing hydrocodone, 3.2M Oxycodone and a little north of a quarter of a million who have been prescribed fentanyl.
• 745,000 or 7.4% of Americans with OUD misuse He**in.
• 404,000 or 4% of the OUD cohort abuse He**in and pain relievers.
• This decline in opioid misuse most impacted the 12-17 y/o and 18-25 y/o age groups.
• In 2019 both pain reliever and He**in misuse initiates (first time use) declined significantly compare to the prior three years. This decline was dramatic in the He**in category.
• He**in use in the 18-25 y/o group was down to 87,000 or 0.3% in 2019 from a whopping 227,000 in 2016.
• But importantly, a significant and steady decline in OUD has been realized in all age groups since 2016

Regarding the misuse of pain relievers, roughly half or 50.8% got their drug from a friend or relative. 37.5% received a prescription from a health care provider (includes stolen scripts) and 6.2% used a dealer. The remaining five and a half percent got their drugs some other way.

TREATMENT and MAT
There have also been significant treatment gains with almost a million and a half individuals with
OUD now receiving some iteration of Medication Assisted treatment (MAT):
• M**hadone 637,157 in 2019 compared to half that number in 2016
• Buprenorphine use up to 746,866 from roughly 520K in 2016
• Naltrexone use 77,872 in 2019 compared with 46,860 in 2016

Summary: OUD in the US in 2019 compared to 2018:

•Opioid use disorder decreased significantly from 2.0M to 1.6M. Efforts to increase access to Medication-Assisted Treatment, psychosocial and community recovery supports have had a positive effect.
•Among those aged 12+, opioid misuse decreased significantly from 2017 and for those 12-17, opioid misuse decreased significantly from 2018.
•Pain reliever misuse decreased significantly from 2018 for those 12-17 years of age and continues trending downward for 18-25 year olds.
•He**in initiation decreased significantly with a 57% decline from 2018.
•He**in use among 18-25 year olds decreased significantly from 2018.
•Despite gains opioid overdose deaths increased in 2019 by approximately 4.6% underscoring the risks of potent illicit synthetic opioids and need to continue to engage people in treatment/recovery services.
•Buprenorphine continues to be the opioid with the highest percentage of users acknowledging misuse of the medication.

Ma*****na Use: Health Concerns
Ma*****na use has increased in all age groups since 2016.

Ma*****na Use: Health Concerns
•Use during pregnancy may be associated with fetal growth restriction, stillbirth, preterm birth, and neonatal intensive care unit admission (Metz and Borgelt, 2018; Stickrath, 2019).
•Use linked to depression/suicide: adolescents (Roberts BA, 2019), veterans (Kimbrelet al., 2018)
•Use in adolescence is associated with increased risk for psychotic disorders in adulthood and is linked with suicidal ideation or behavior (D’Souza et al, 2016; McHugh et al, 2017).
•The risk for psychotic disorders increases with frequency of use, potency of the ma*****na product, and as the age at first use decreases (NASEM, 2017).
•Use among adolescents is linked to a decline in IQ and is associated with educational drop out (Meier, 2012).
•Use has been linked to the development of drug use disorders including alcohol, to***co and other illicit drugs (NASEM, 2017).
•Ma*****na intoxication is an important cause of MVAs associated with injury and death—it is wrong to say that ma*****na use never killed anyone (NASEM, 2017).
•Association between state laws allowing medical ma*****na and opioid overdose mortality reversed direction from -21% (1999-2010) to +23% (1999-2017). (Shover, et al., 2019)
•Risk of subsequent prescription opioid misuse and use disorder was increased among people who reported ma*****na use 5 years earlier (Olfsonet al., 2017)

CO***NE USE: No statistically significant change noted since 2016
METHAMPHETAMINE:
M**h use up to 1.7M or 0.8% in 2019 from 1.1M (0.5%) in 2016 in the 26 y/o and older cohort.

PRESCRIBED STIMULANTS:
Misuse of stimulants has declined significantly in the 18-25 y/o cohort from 2.6M to 2.0M over the last 4 years.

L*D
Use has increased in all age groups but most significant in the 12-17 y/o group.

SUMMARY: Other Substance Use in the US in 2019 compared to 2018:
•Past month ma*****na use and past year daily or almost daily ma*****na use
significantly increased in adults aged 26+
•Past year ma*****na use disorder significantly increased in adolescents
•Non-significant increase in ma*****na use by pregnant women; significant increases in
ma*****na use by women 15 44
Alcohol and to***co use trending downward in pregnant women; but any alcohol or
to***co use is hazardous in pregnancy
•No change in co***ne use in all age groups
•Upward trend in methamphetamine use and significantly increased over 2016 17 in
adults 26 and older
•Prescription stimulant misuse trending downward in those 18 25 years old
•Past year L*D use significantly increased in adolescents; non-significant increases in
L*D use in young adults and adults
Summary: Other Substance Use in the United States in 2019 Compared to 2018

01/17/2020

01/17/2020

08/18/2018

1. Improving access to care in SUD through proactive community engagement, exploiting key intervention points (i.e. emergency rooms) and facilitating warm handoffs from ECC to ARF following overdose 2. The Neurobiological basis for impaired decision making in active addiction, clinical implications....

08/17/2018

08/17/2018

https://www.researchgate.net/profile/John_Moritz3

04/18/2018

Animal research plays a fundamental role in medical, veterinary and scientific progress. From the development of insulin and transplant surgery to modern day advances, including gene therapies and cancer treatments; animals – from mice to monkeys – continue to play a crucial role in both basic ...

04/16/2018

NIH-funded researchers and Google show machine learning can be applied to biomedical research.

04/16/2018

NIH’s efforts contribute to a government-wide push to meet the President’s goal of ending the opioid crisis.

04/16/2018

04/16/2018

One of the pillars of the current federal initiatives to end the opioid crisis is the development of new medications to treat opioid addiction. The FDA Patient-Focused Drug Development Initiative (PFDD), established in 2012, seeks to solicit patient perspectives on which symptoms are most important....

04/16/2018

Thousands of young people across the country are helping scientists unlock mysteries of the developing teen brain.

03/27/2018

I have been an internist-hospitalist (Certified-American Board of Internal Medicine) for nearly 20 years, with a demonstrated history leadership and working in the hospital & health care industry. I had the privilege of serving as the Medical Director for our hospitalist team at Sarasota Memorial Hospital for 5 years. I am also an Associate Clinical Professor of Medicine for FSU. A few years ago, I started to develop a growing professional discontent for the lack of specialized addiction care our SUD patients received. As I studied the problem from both health system and provider perspectives it became clear that there exists a huge disconnect between the demand for specialized treatment and availability. Moreover, there exists a massive chasm between the science of addiction and what is practiced in clinics throughout America. REFORM begins at home. So thusly energized and committed to be part of the solution, I vigorously hit the books and conferences to educate myself about the problem of Substance Use Disorder. I went on to become Board Certified in Addiction Medicine through the American Board of Preventative Medicine. For the last year I have been engaged in a mid-career pivot from traditional hospitalist to clinical investigator and addiction specialist. I recently joined a small group of like-minded neuroscientists and clinicians from the FSU College of Medicine campus in Tallahassee and here in Sarasota. We have collaborated to augment our understanding of SUD from both clinical and basic science perspectives, and this is a daunting yet most exciting endeavor!

I am dual boarded by the American Board of Internal Medicine and The American Board of Preventative Medicine – Addiction Medicine. I have been elected Fellow of the American College of Physicians, and I am an Assistant Clinical Professor of Medicine at FSU College of Medicine (SRQ Campus).