Animal Study Suggests Lorcaserin (Belviq®) May be Useful to Reduce Opioid Intake

MedicalResearch.com Interview with:
Christina R. Merritt and Kathryn A. Cunningham
Center for Addiction Research
University of Texas Medical Branch
Galveston, TX 77555

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Opioid use disorder (OUD) is one of the top public health problems in the United States. Overdoses on prescription opioids, heroin and fentanyl accounted for 33,091 deaths in the U.S. in 2015 (https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm); each day, 91 Americans die from an opioid overdose (https://www.cdc.gov/drugoverdose/epidemic/). The first-ever Surgeon General’s Report on Alcohol, Drugs and Health (https://addiction.surgeongeneral.gov/ ) observed that more people used prescription opioids than tobacco in 2015. Furthermore, individuals with OUD, the most problematic pattern of opioid abuse, often relapse, particularly in environments associated with past drug use, and new means to help maintain abstinence are needed.

Serotonin (5-hydroxytryptamine; 5-HT) function in the brain, particularly through its cognate 5-HT2C receptor, is an important regulator of the abuse liability of cocaine and other psychostimulants. Previous studies suggested that the weight loss medication and selective 5-HT2C receptor agonist lorcaserin (Belviq®) can curb cocaine- and nicotine-seeking in preclinical models, even when tested in tempting environments. We administered lorcaserin to rats who were trained to take the powerful painkiller oxycodone (OxyContin®), a prescription opioid currently approved for treatment of acute and chronic pain with characteristically high abuse potential. Lorcaserin suppressed oxycodone intake as well as the drug-seeking behaviors observed when rats were exposed to cues such as the lights and sounds previously associated with drug intake. Taken together, these findings highlights the therapeutic potential for lorcaserin to extend abstinence and enhance recovery from OUD.

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Some Retirees Begin Risky Alcohol Consumption

MedicalResearch.com Interview with:
Jaana Halonen, Docent and Senior Researcher

Finnish Institute of Occupational Health

MedicalResearch.com: What is the background for this study?

Response: Retirement is a significant life transition when substantial changes in daily life are experienced as retirees adapt to life without work. After retirement people have more leisure time and more opportunities for different activities, and less stress. These changes are positive, but retirement can also lead to reduced social control and loss of social contacts and therefore be perceived as a stressful life transition. Both the positive and negative aspects related to changes in leisure time, stress, and social networks around retirement may affect drinking behaviours. However, little is known about how risky alcohol consumption changes around the retirement transition.

Thus, in our study we wanted to examine how and for whom risky drinking changes around the time of retirement. To do that we followed up public sector workers with questionnaires before and after their old-age retirement.

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Buprenorphine Prescriptions for Opioid Use Disorder Rise With Medicaid Expansion

MedicalResearch.com Interview with:

Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health

Dr.Hefei Wen

Hefei Wen, PhD
Assistant Professor, Department of Health Management & Policy
University of Kentucky College of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment (MAT) for opioid use disorder.

We found a 70% increase in Medicaid-covered buprenorphine prescriptions and a 50% increase in buprenorphine spending associated with the implementation of Medicaid expansions in 26 states during 2014. Physician prescribing capacity was also associated with increased buprenorphine prescriptions and spending.

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Combination Opioids and Benzodiazepines Raises Risk of Overdose

MedicalResearch.com Interview with:

Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA

Dr. Eric Sun

Eric C Sun MD PhD, assistant professor
Department of Anesthesiology
Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%.

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Cannabidiol Reduces Fear and Anxiety in Various Preclinical Models

MedicalResearch.com Interview with:
Carl Stevenson, PhD

Assistant Professor of Neuroscience
BSc Animal Science Admissions Tutor
Local Group Rep, British Neuroscience Association
School of Biosciences
University of Nottingham
Loughborough, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Anxiety-related and substance abuse disorders can be serious forms of mental illness that are not always treated effectively by psychological therapies or medications. One strategy to enhance their treatment is to boost the effects of psychological therapy by combining it with medication.

This study reviewed the literature on the effects of cannabidiol, a chemical found in the cannabis plant, in preclinical models of these disorders. Cannabidiol is safe to use in humans and doesn’t cause the ‘high’ associated with cannabis. This means that cannabidiol might be useful for treating certain symptoms without the unwanted side effects linked to medical cannabis.

Our review confirmed that cannabidiol reduces fear and anxiety in various preclinical models, when given on its own or in conjunction with behavioural interventions that model psychological treatment for anxiety-related disorders. Our review suggested that it can also reduce relapse in some preclinical models of addiction, although research looking at the effects of cannabidiol in substance abuse disorders is still in its infancy.

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Fentanyl Laced Heroin Contributing To Spike In Heroin Overdoses in Miami-Dade County

MedicalResearch.com Interview with:
Alexander Diaz Bode

M.D. Candidate
University of Miami Leonard M. Miller School of Medicine
Miami, FL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our country is in the midst of an opiate epidemic. This is particularly evident in the emergency department (ED), which continues to see an alarmingly large number heroin overdose. With the shutdown of “pill-mills”, where opioid prescriptions would be prescribed indiscriminately, Florida has seen particularly large increases in opiate use and overdose. In Miami, we noticed that during the summer of 2016, there was a disproportionate increase in heroin overdose being treated at our hospital relative to previous years. Our recently published study showed that fentanyl or fentanyl analog laced heroin likely contributed to this massive spike in heroin overdose observed during the summer of 2016.

Fentanyl and its synthetic analogs are opioid receptor agonists that bind with hundreds of times higher affinity than diamorphine, aka heroin. Naloxone, better known by the brand name Narcan®, is used to reverse heroin overdose in the ED. This drug works by competitively inhibiting the opioid receptor, effectively “knocking off” the bound heroin. Using naloxone dosing as a surrogate marker of heroin purity, our study found that during the investigated spike there was a disproportionate increase in the amount of naloxone used in our ED to reverse overdose relative to the increase in opiate overdose. This indicated that a stronger opioid receptor agonist, such as fentanyl or fentanyl analogs, likely was involved in the massive spike in overdose observed during the summer of 2016.

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Memory Retrieval and Extinction Reduces Craving For Cigarettes

MedicalResearch.com Interview with:

Michael E. Saladin, Ph.D. Professor, Department of Health Sciences and Research College of Health Professions Medical University of South Carolina Charleston, SC

Dr. Michael Saladin

Michael E. Saladin, Ph.D.
Professor, Department of Health Sciences and Research
College of Health Professions
Medical University of South Carolina
Charleston, SC

MedicalResearch.com: What is the background for this study?

Response: To the extent that learning and memory processes govern all aspects of behavior, they also govern dysregulated or maladaptive behaviors such as addiction and anxiety states. In the former case, stimuli associated with drug administration can acquire the ability to control drug-related motivational states (urges and craving) as well as drug seeking behavior. To illustrate the point, the simple act of observing a person light up a cigarette will cause the typical smoker to desire a cigarette and engage in smoking. A nonsmoker, by contrast, would not be similarly affected because they have no history where stimuli associated with smoking (e.g., sight of a lighter, cigarettes, plumes of smoke) are reliably paired with, or followed by, the rewarding effects of nicotine.

The research we conducted recently was based on neuroscience research showing that retrieved drug-associated memories (prompted with drug-paired cues) can be updated with information that decreases drug craving and/or administration. One such study showed that heroin craving in heroin addicts can be decreased by retrieving memories for heroin use via a brief heroin cue presentation (video of people using heroin) and then, a short time later, presenting an extensive variety of heroin cues (video, pictures and heroin use paraphernalia) over a 1-hour period. The logic of this intervention was that once the heroin memories were prompted into a labile state by the brief video presentation, the extensive heroin cue exposure would serve to update the content of the original memories with new information (i.e., cues are not followed by heroin reward) that is inconsistent with the original cue-drug contingency (i.e., cues are followed with heroin reward). Remarkably, just two sessions of this type of training, which we call retrieval-extinction training, resulted in significant reductions in heroin craving that persisted for six months. This study was done with heroin addicts who were inpatients so there was no way to assess the effects of this treatment on actual heroin use.

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Competitive Athletes At Risk For Addiction

MedicalResearch.com Interview with:
Laurie de Grace

Master’s graduate from the Faculty of Physical Education and Recreation
University of Alberta

MedicalResearch.com: What is the background for this study?

Response: Little is known about the development of substance addiction in the context of sport. There is substantial evidence showing a positive association between sport participation and alcohol use, particularly the binge drinking that is more commonly associated with athletes than non-athletes. However, the connection between sport participation and the use of other substances is not clear. We undertook this study to learn from the perspective of those in recovery from substance addiction, how sport may or may not have played a role in their substance use and subsequent addiction.

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Scientists Block Cocaine Addiction in Mice by Increasing Cadherin “glue” at Synapses

MedicalResearch.com Interview with:

Andrea K. Globa, Ph.D. Candidate Graduate Program in Neuroscience Life Sciences Institute University of British Columbia Vancouver, BC, Canada

Andrea Globa

Andrea K. Globa, Ph.D. Candidate
Graduate Program in Neuroscience
Life Sciences Institute
University of British Columbia
Vancouver, BC, Canada

MedicalResearch.com: What is the background for this study?

Response: Addiction is a complex disease, characterized by continued substance use despite serious negative consequences, increased drug tolerance, and withdrawal. In fact, the statistics show that over 40 million Americans abuse or are addicted to nicotine, alcohol or other drugs. This is a huge public health issue, so naturally, scientists are interested in figuring out why people get addicted, and in particular why certain people are more prone to addiction than others.

Studies examining genetic differences in addicted populations have shown that there are many mutations in genes that are important for brain function. One group of genes affected encode proteins that act as ‘glue’ to hold cells together. These proteins are called cadherins. In the brain, cadherins are important for holding brain cells together at spots where they communicate with one another – and these points where brain cells talk to one another are called synapses.

Many neuroscientists believe that addiction is actually a type of “pathological” learning, where there are changes at synapses in a brain circuit involved in reward and motivation. So we decided to examine the molecular mechanisms that are important for the strengthening of synapses in this brain circuit.

To put it very simply, to learn something you have to make your synapses stronger, and this involves adding more cadherin or ‘glue’ to the synapse. We wanted to see if these same rules held true in addiction.

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Brain-Reward Circuit Both Under and Over Responsive in Addiction and Gambling

MedicalResearch.com Interview with:

Guillaume Sescousse, PhD Senior post-doc Donders Centre for Cognitive Neuroimaging The Netherlands

Dr. Guillaume Sescousse

Guillaume Sescousse, PhD
Senior post-doc
Donders Centre for Cognitive Neuroimaging
The Netherlands
with collaborators Maartje Luijten, PhD,
and Arnt Schellekens, MD PhD

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: People with an addiction process rewards in their brain differently from people who are not addicted. However, whether this is associated with “too much” or “too little” brain activity is an open question. Indeed, past research has produced conflicting findings.

In order to get a reliable answer, we have combined 25 studies investigating brain reward sensitivity in more than 1200 individuals with and without addiction to various substances such as alcohol, nicotine or cocaine but also gambling. By analyzing the brain images from these studies, we have discovered an important difference in brain activity between expecting a reward and receiving a reward. Compared with non-addicted individuals, individuals with substance or gambling addiction showed a weaker brain response to anticipating monetary rewards. This weaker response was observed in the striatum, a core region of the brain reward circuit, possibly indicating that individuals with an addiction have relatively low expectations about rewards. In contrast, this same region showed a relatively stronger response to receiving a reward in individuals with substance addiction compared with non-addicted individuals.

This stronger response possibly indicates a stronger surprise to getting the reward, and is consistent with low expectations. This same effect was not found among people addicted to gambling.

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Reasons for Drug Policy Reform: Millions of People are Left with Untreated Pain

MedicalResearch.com Interview with:
Dr. Katherine Irene Pettus, PhD, OSB

Advocacy Officer International Association for Hospice and Palliative Care
Vice Chair, Vienna NGO Committee on Drugs
Secretary NGO Committee on Ageing, Geneva

MedicalResearch.com: What is the background for this study?

Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries.

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Which Patients Stick With Office Based Opioid Treatment with Buprenorphine?

MedicalResearch.com Interview with:

Zoe M. Weinstein MD Assistant Professor of Medicine, Boston University Director, Addiction Consult Service, Boston Medical Center 801 Massachusetts Ave. Crosstown 2 #2039 Boston MA 02118

Dr. Zoe Weinstein

Zoe M. Weinstein MD
Assistant Professor of Medicine, Boston University
Director, Addiction Consult Service
Boston Medical Center
Boston MA 02118

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Like other chronic, life-long medical conditions such as hypertension or diabetes, opioid use disorder (OUD) requires long-term engagement in therapy; however many individuals who participate in Office Based Addiction Treatment are not able to be retained in care long-term.

This observational study followed more than 1,200 patients over 12 years with the goal of identifying patient-specific factors associated with retention in the treatment program for longer than one year. While the study found that older age, female, and co-morbid psychiatric diagnosis were associated with greater odds of treatment retention beyond one year, patients who were black or Hispanic, unemployed, and had evidence of hepatitis C viral infection were associated with decreased odds of treatment retention beyond one year.

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