Addiction Withdrawal Treatment Using Transcranial Magnetic Stimulation

MedicalResearch.com Interview with:

Crystal meth – illicit methamphetamine hydrochloride

Crystal meth – illicit methamphetamine hydrochloride

TiFei YuanPhD
School of Social and Behavioral Sciences, Nanjing University, Nanjing, China
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
School of Psychology, Nanjing Normal University, Nanjing, China

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

Response: Addiction is causing serious challenge to public health. Few drugs can treat or even alleviate addiction.

In recent years, non-invasive brain stimulation has been used to modulate craving responses in different types of drug addicts (heroin, methamphetamine, cocaine), and to prevent smoking or alcohol abuse.

However it is unknown if brain stimulation can also help addicts get rid of the aversive symptoms in the early withdrawal period.

The present study is to our knowledge, the first trial to alleviate drug withdrawal symptoms and associated insomnia with non-invasive transcranial magentic stimulation.  Continue reading

Adolescents Face Large Addiction-Treatment Gap

MedicalResearch.com Interview with:

Scott E. Hadland, MD, MPH, MS Assistant Professor of Pediatrics Boston Medical Center / Boston University School of Medicine

Dr. Hadland

Scott E. Hadland, MD, MPH, MS
Assistant Professor of Pediatrics
Boston Medical Center / Boston University School of Medicine

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

Response: Amidst a worsening overdose epidemic in the United States, adolescents and young adults have not been spared. Although evidence-based medications like buprenorphine, naltrexone, and methadone are recommended for adolescents and young adults, the extent to which youth receive these medications — and whether these medications help retain youth in addiction treatment — isn’t yet known.

Continue reading

Illicit Drug Use Spikes During Special Events

MedicalResearch.com Interview with:
Bikram Subedi, PhD Assistant Professor of Analytical Chemistry Murray State University, Murray KYBikram Subedi, PhD

Assistant Professor of Analytical Chemistry
Murray State University, Murray KY

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

Response: The USA is one of the major consumers of diverse neuropsychiatric and illegal drugs, and recently declared a national public health emergency on opioid abuse. Law enforcement typically utilized conventional methods of determining drug consumption rate which are based on survey questionnaire, hospital admissions, drug-related crime statistics, and self-reported information. Conventional methods typically underestimate the actual consumption rate of drugs.

Our new approach of determining consumption rates of drugs in community is time and cost effecting and comprehensive. Based on levels of drugs quantified from raw sewage, the per capita consumption rates of several illicit drugs including methamphetamine, amphetamine, cocaine, and THC in two communities of Western Kentucky (similar population and only ~50 miles apart) were significantly different. During special events such as July 4th and 2017 solar eclipse, the consumption rates were found even higher. The consumption rate of methamphetamine was among one of the highest ever reported in the country.  Continue reading

Veterinarians Fear Humans May Divert Opioids Intended for Pets

MedicalResearch.com Interview with:
“Pets” by GRANT DAWSON is licensed under CC BY 2.0Derek S. Mason, MPH

Colorado University School of Medicine
MD Candidate, Class of 2022
Anschutz Medical Campus, Aurora, CO

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

Response: The background for this report stems from a focus group of veterinarians that was held and identified that opioid diversion could be occurring within clinics.

After this, we became concerned that human patients were indeed diverting opioids for abuse and misuse and we wanted to get a broader sense from the veterinary medical community if they had been aware of opioid diversion happening within their clinics.

Additionally, we noticed that there was a gap in the scientific literature on how the veterinary medical community feels about the opioid epidemic. As prescribers of opioids, we felt that their input was highly valuable and should be included in the discussion on how to prevent opioid abuse and misuse.  Continue reading

Experimental Injection Reduces Cocaine Craving

MedicalResearch.com Interview with:

Ana-Clara Bobadilla, Ph.D. Postdoctoral scholar in the laboratory of Peter Kalivas, Ph.D MUSC  Photo by Sarah Pack Medical University of South Carolina

Dr. Ana-Clara Bobadilla (Sarah Pack, photographer)

Ana-Clara Bobadilla, Ph.D.
Postdoctoral scholar
in the laboratory of Peter Kalivas, Ph.D
MUSC 

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

Response: The Brain-derived neurotrophic factor (BDNF) is a growth factor that has well-described effects in the survival, growth and differentiation of neurons during development of the central nervous system, but it also maintains a role during adulthood in learning, memory and various disorders such as addiction. Several clinical studies show increased BDNF levels in the serum of cocaine- or alcohol-dependent patients compared to controls (D’Sa et al., 2011; D’Sa et al., 2012). In preclinical research, a wealth of studies shows that chronic exposure to drugs of abuse impacts BDNF expression in different parts of the brain, including the main regions comprised in the reward circuitry, the cortex and the nucleus accumbens (for a comprehensive review, see Li & Wolf, 2015). Conversely, altering BDNF expression or transmission has profound effects on the response of the brain to drugs (see McGinty et al., 2010). Importantly, BDNF effects are often region-specific, meaning that an increase in BDNF expression in one region can decrease the effects of drug exposure in the brain while the same increase in another region can have opposite effects (Li et al., 2013). Because BDNF transmission can modify the expression of a wide range of genes leading to long-term modifications, numerous studies administer BDNF early in the drug exposure protocol and focus on the long-term changes induced by the growth factor.

In this study, we microinjected BDNF directly in the nucleus accumbens minutes before measuring cocaine craving in a well-known rodent model of relapse. We found that BDNF induces a robust decrease in craving that lasts for at least 3 days post-treatment. The inhibitory effect of BDNF is not seen when animals are tested for sucrose, a very strong reward for rats, suggesting that this effect is specific to cocaine.

Moreover, cocaine craving is only decreased when BDNF is microinjected before the craving test, but has no effect when injected a day before the craving test or in the home cage, indicating a time-specificity in addition to the region-specificity previously described.  Continue reading

LUCEMYRA (Lofexidine) Now Available to Reduce Opioid Withdrawal Symptoms

MedicalResearch.com Interview with:

Mark Pirner, MD, PhD Senior Medical Director Clinical Research and Medical Affairs US WorldMeds

Dr. Mark Pirner

Mark Pirner, MD, PhD
Senior Medical Director
Clinical Research and Medical Affairs
US WorldMeds

MedicalResearch.com: What is the background for this announcement? How does lofexidine differ from other opioid withdrawal medications?

Response: LUCEMYRA™ (lofexidine) was FDA-approved on May 16 as the first and only non-opioid, non-addictive medication for the management of opioid withdrawal in adults.
LUCEMYRA mitigates the acute and painful symptoms of opioid withdrawal by suppressing the neurochemical surge in the brain that occurs when opioids are abruptly discontinued.

In clinical studies, patients receiving treatment with LUCEMYRA experienced greater symptom relief and were significantly more likely to complete their withdrawal. LUCEMYRA is not an opioid drug and is not a treatment for opioid use disorder; it should be used as part of a longer-term treatment plan.

Continue reading

Bariatric Surgical Approach To Increase Bile Acids May Reduce Cocaine Reward

MedicalResearch.com Interview with:

Aurelio Galli, Ph.D. Professor of Molecular Physiology & Biophysics and Psychiatry & Behavioral Science Associate Director for Research Strategy Vanderbilt Brain Institute

Dr. Galli

Aurelio Galli, Ph.D.
Professor of Molecular Physiology & Biophysics and Psychiatry & Behavioral Science
Associate Director for Research Strategy
Vanderbilt Brain Institute

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

Response: The study builds on evidence that bile acids influence the brain’s reward system. Bile acids are normally released from the gall bladder into the upper part of the small intestine, where they emulsify fats for absorption, before being recycled further down the small intestine. In bile diversion surgery, an experimental treatment for weight loss, bile is released at the end of the small intestine, increasing the amount of bile acids that enter the general circulation.

Mice treated with this surgery have less appetite for high-fat foods, which suggests that bile acids affect brain reward pathways.

We demonstrated that mice receiving the surgery also showed less preference for the cocaine-associated chamber, indicating that cocaine was probably less rewarding. Continue reading

Opioid Prescription Rates Higher in South, Appalachia and Rural West

MedicalResearch.com Interview with:

Dr. Lyndsey Rolheiser MD Postdoctoral Research Fellow at Harvard Center for Population Studies Cambridge, Massachusetts

Dr. Rolheiser

Dr. Lyndsey Rolheiser PhD
Postdoctoral Research Fellow at Harvard Center for Population Studies
Cambridge, Massachusetts

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

Response: The opioid crisis was declared a “public health emergency” in 2017. Opioid related overdoses and prescribing rates have increased dramatically over the past decade and previous literature has identified a relationship between high-dose prescriptions and overdose deaths. Thus, understanding the variation and trends in the opioid prescribing rate is crucial in understanding the nature of the opioid epidemic. Opioid prescribing data is publicly available at the county and state level.

County level data represents an administrative boundary that lacks political representation and accountability. In contrast, the congressional district represents a geography that has both of these characteristics. Further, knowing the congressional district level rates allows for policy makers and researchers to observe the variation that exists within states.

The main findings are high prescribing rate districts are concentrated in the South, Appalachia and the rural West. Low-rate districts are concentrated in urban centers.

MedicalResearch.com: What should readers take away from your report?

Response: There is a great deal of variation across congressional districts, but there are also very clear geographical patterns. In terms of policy, this paper highlights the importance of constructing and disseminating crucial public health data at a politically relevant boundary.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our hope is that the estimates we have created can be used within health related public policy research.

Citation: Lyndsey A. Rolheiser, Jack Cordes, BSPH, S.V. Subramanian. Opioid Prescribing Rates by Congressional Districts, United States, 2016. American Journal of Public Health, 2018; e1 DOI: 10.2105/AJPH.2018.304532

Jul 22, 2018 @ 11:46 am

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Age 21 Can Define Lifelong Drinking Patterns

MedicalResearch.com Interview with:
“undefined” by Iñaki Queralt is licensed under CC BY 2.0Richard Saitz, MD, MPH, FACP, DFASAM

Chair and Professor,Department of Community Health Sciences
Boston University School of Medicine

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

Response: Most of what we know about the time course of drinking too much (at-risk use) is from people in treatment or special groups and not adults in the US population at large. That’s why we did this study. We need to know how often at-risk drinking persists, how often it resolves, and how often it appears de novo.

Risky drinking means exceeding limits that are associated with health consequences. It includes people with an alcohol use disorder but the vast majority of people drinking risky amounts do not have a disorder, they are simply drinking amounts that can harm their health. Even low amounts can harm health (e.g. breast cancer risk increases at <1 drink a day) but substantial increases in risk occur over 7 in a week on average (for women, and 14 for men) or >5 for men (>4 for women) on an occasion. The latter are associated with acute consequences (e.g. injury, unwanted sex), and the former with chronic conditions (e.g. cirrhosis). People should be aware of their risks and then they can make choices about what risks they want to take (and for those with a disorder, they may need help with those choices and help changing behavior like treatment).

The main findings were….that 3 years later, 3/4ths of adults drinking risky amounts were still doing so. But importantly, a quarter had stopped drinking risky amounts. It is important to know that things change. One factor associated with that positive change was having kids—presumably a positive social change even if stressful.  Of those adults not drinking risky amounts when first interviewed, 15% started doing so 3 years later. Again having children was protective but the main factor associated with starting was young age, particularly those who became of legal drinking age. Despite the fact that youth may be able to access alcohol illegally, this finding confirms that the drinking age of 21 in the US does in fact restrict access, and that turning 21 increases use and risky use by making alcohol more accessible. Continue reading

Surgery For Spondylolisthesis (Spinal Stress Fractures) Reduced Chances of Opioid Dependence

MedicalResearch.com Interview with:

Beatrice Ugiliweneza, PhD, MSPH Assistant Professor Kentucky Spinal Cord Injury Research Center Department of Neurosurgery, School of Medicine Department of Health Management and Systems Science School of Public Health and Information Sciences University of Louisville

Dr. Ugiliweneza

Beatrice Ugiliweneza, PhD, MSPH
Assistant Professor
Kentucky Spinal Cord Injury Research Center
Department of Neurosurgery, School of Medicine
Department of Health Management and Systems Science
School of Public Health and Information Sciences
University of Louisville

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

Response: This study stems from the observed opioid crisis in the United States in recent years. Opioids are used in the management of pain. In the spine population, back pain is one of the main conditions for which opioids are consumed.

A frequent cause of that pain is degenerative spondylolisthesis. We aimed to evaluate the effect of surgery, which has been shown to improve outcomes, on opioid dependence. We found that surgery is associated with reduced odds of opioid dependence.

MedicalResearch.com: What should readers take away from your report? 

Response: One interesting finding that we observed is that patients are twice less likely to become opioid dependent than they are to become dependent after surgery. However, an important note to keep in mind is that about 10% of patients will be opioid dependent after surgery (about 6% prior non-dependent and 4% prior dependent).  

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Surgery has been proven to improve clinical outcomes and quality of life for patients with degenerative spondylolisthesis. Future research should explore why some patients remain or become opioid dependent after surgery.

It would also be interesting to look at the effect of other treatments for degenerative spondylolisthesis (such as epidural steroid injections for example) on opioid dependence.

MedicalResearch.com: Is there anything else you would like to add?

Response: Spine surgeons should have systems that help them recognize patients who are likely to become opioid dependent after surgery. Our paper discusses factors to watch for such as younger age, prior dependence, etc… This would help provide targeted attention and hopefully combat the ramping opioid crisis.

The authors have no disclosures. 

Citation:

Journal of Neurosurgery: Spine
Posted online on June 19, 2018.
Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases
Mayur Sharma, MD, MCh, Beatrice Ugiliweneza, PhD, MSPH1, Zaid Aljuboori, MD1, Miriam A.Nuño, PhD2, Doniel Drazin, MD3, and  Maxwell Boakye, MD, MPH, MBA1

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Potentially 70,000 Opioid-Related Overdose Deaths Undercounted

MedicalResearch.com Interview with:

Jeanine M. Buchanich, Ph.D. Research associate  Professor in the University of Pittsburgh Graduate  School of Public Health’s Department of Biostatistics

Dr. Buchanich

Jeanine M. Buchanich, Ph.D.
Research associate
Professor in the University of Pittsburgh Graduate
School of Public Health’s Department of Biostatistics

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

Response: In the U.S., cause of death codes are assigned by the National Center for Health Statistics (NCHS) using information reported by the coroner or medical examiner completing the death certificate. Drug-specific overdose deaths are identified by the contributory causes of death, which are categorized as “T codes” and are assigned based on the specific drugs recorded by the coroner or medical examiner completing the death certificate. A code of T50.9 means “other and unspecified drugs, medicaments and biological substances.”

My colleagues and I extracted death data by state for 1999 through 2015 from the NCHS’s Mortality Multiple Cause Micro-data Files. We grouped overdose deaths into opioid-related, non-opioid-related and unspecified codes. In five states – Alabama, Indiana, Louisiana, Mississippi and Pennsylvania – more than 35 percent of the overdose deaths were coded as unspecified.

We then calculated the change in percentage of overdose deaths that fell into each category from 1999 to 2015 by state. In those 17 years, opioid-related overdose deaths rose 401 percent, non-opioid-related overdose deaths rose 150 percent and unspecified overdose deaths rose 220 percent.

This allowed us to extrapolate how many of the unspecified overdose deaths were likely opioid-related. By our calculations, potentially 70,000 opioid-related overdose deaths were not included in national opioid-related mortality estimates since 1999 because coroners and medical examiners did not specify the drug that contributed to the cause of death when completing the death certificates.  Continue reading

Buprenorphine Exposures Among Children and Adolescents

MedicalResearch.com Interview with:

Gary Smith, MD, DrPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Dr. Smith

Gary A. Smith, MD, DrPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH

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

Response: Buprenorphine is a prescription opioid medication commonly used to treat opioid use disorder. From 2005 to 2010, the annual number of individual patients who received a buprenorphine prescription increased from 100,000 to more than 800,000. Although buprenorphine is important for the treatment of opioid use disorder, pediatric exposure to this medication can result in serious adverse outcomes.

Continue reading

More Medicaid Enrollees Receiving Treatment for Opioid Use Disorder, But Disparities Remain

MedicalResearch.com Interview with:

Bradley D. Stein MD PhD Senior Physician Policy Researcher Pittsburgh Office Rand Corporation

Dr. Stein

Bradley D. Stein MD PhD
Senior Physician Policy Researcher
Pittsburgh Office
Rand Corporation

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

Response: Increasing use of medication treatment for individuals with opioid use disorders, with medications like methadone and buprenorphine, is a critical piece of the nation’s response to the opioid crisis. Buprenorphine was approved by the FDA in 2002 for treatment of opioid use disorders, but there was little information about to what extent buprenrophine’s approval increased the number of Medicaid-enrollees who received medication treatment in the years following FDA approval nor to what extent receipt of such treatment was equitable across communities.

Continue reading

Concurrent Opioids and Benzodiazepines Raise Risk of Overdose, esp. Early On

MedicalResearch.com Interview with:

Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh, PA 15261

Dr. Hernandez

Inmaculada Hernandez, PharmD, PhD
Assistant Professor of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Pittsburgh, PA 15261

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

Response: Prior research has found that taking opioids and benzodiazepines simultaneously increases the risk of overdose by 2 to 3 fold, when compared to opioid-use only.

However, prior to our study, it was unclear how the risk of overdose changes over time with the concurrent use of opioids and benzodiazepines.

Continue reading

Most Patients Who Survive Overdose Do Not Receive FDA Approved Medications for Opioid Use Disorder

MedicalResearch.com Interview with:

Marc R. Larochelle, MD, MPH Assistant Professor of Medicine Boston University School of Medicine Boston MA

Dr. Larochelle


Marc R. Larochelle, MD, MPH

Assistant Professor of Medicine
Boston University School of Medicine
Boston MD 

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

Response: In this study we examined more than 17,000 individuals who survived an opioid overdose in Massachusetts between 2012 and 2014.

We were interested in identifying how many went on to receive one of the three FDA-approved medications for opioid use disorder (MOUD), and whether or not they were associated with mortality.

We found that only 3 in 10 received MOUD and that receipt of buprenorphine and methadone were associated with 40-60% reduction in all-cause and opioid-related mortality.

We found no association between naltrexone and mortality though the confidence of this conclusion is limited by the small number who received naltrexone in this cohort.

Continue reading

Treatment Initiation for Opioid Use Disorder in Emergency Departments

MedicalResearch.com Interview with:

Herbie Duber, MD, MPH, FACEP Associate Professor, Emergency Medicine Adjunct Associate Professor Department of Global Health Adjunct Associate Professor, Institute for Health Metrics and Evaluation University of Washington

Dr. Duber

Herbie Duber, MD, MPH, FACEP
Associate Professor, Emergency Medicine
Adjunct Associate Professor Department of Global Health
Adjunct Associate Professor
Institute for Health Metrics and Evaluation
University of Washington

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

Response: Opioid use disorder (OUD) and opioid overdose deaths are a rapidly increasing public health crisis.  In this paper, we review and synthesize current evidence on the identification, management and transition of patients from the emergency department (ED) to the outpatient setting and present several key recommendations.

For patients identified to haveOpioid use disorder, we recommend ED-initiated mediation-assisted therapy (MAT) with buprenorphine, an opioid agonist.  Current evidence suggests that it safe and effective, leading to improved patient outcomes.  At the same time, a coordinated care plan should be put into motion which combines MAT with a rapid transition to outpatient care, preferably within 72 hours of ED evaluation.  Where possible, a warm handoff is preferred, as it has been shown in other settings to improve follow-up.  Outpatient care should combine MAT, psychological interventions and social support/case management in order to maximize impact Continue reading

Could Restricting Nicotine in E-Cigarettes Do More Harm Than Good?

MedicalResearch.com Interview with:
e-cigarette CDC imageDr Lynne Dawkins, PhD

Associate Professor
London South Bank University

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

Response: Many people think that it’s the nicotine that’s harmful so they opt for using a low strength in their e-liquid. We know from tobacco smoking that when people switch to using a lower nicotine yield cigarette, they compensate in order to maintain a steady blood nicotine level by taking longer, harder drags and this can increase exposure to toxins in the smoke. We also know from some of our other work with vapers (e-cigarette users) that they tend to reduce the nicotine strength of their e-liquid over time. We therefore wanted to explore whether vapers also engage in this compensatory puffing and whether this has any effect on exposure to potentially harmful chemicals.

Continue reading

Neurobiology Links Aggressive Behavior and Addiction

MedicalResearch.com Interview with:

Scott J. Russo PhD Fishberg Dept. of Neuroscience Friedman Brain Institute, and Center for Affective Neuroscience Icahn School of Medicine at Mount Sinai New York, NY

Dr. Russo

Scott J. Russo PhD
Fishberg Dept. of Neuroscience
Friedman Brain Institute, and Center for Affective Neuroscience
Icahn School of Medicine at Mount Sinai
New York, NY 

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

Response: There is increasing evidence that aggressive behavior might share key features with addiction.  For example, aggressive mice develop positive associations with environmental cues associated with previous aggressive encounters (ie. they find aggression rewarding) and aggressive animals will work very hard to obtain access to a subordinate animal in order to attack them.

Some of the same brain regions that are activated in response to addictive drugs, like cocaine and morphine, are also activated by aggressive experience.  Thus we hypothesized that there may be shared neurobiological mechanisms between addiction and aggression.

Our study showed that there is accumulation of the addiction-related transcription factor, ΔFosB, in the nucleus accumbens, a brain region well know to regulate the rewarding and addictive properties of drugs of abuse.

Continue reading

Major Brain Networks With Altered Brain Function In Individuals with Addiction Identified

MedicalResearch.com Interview with:
Professor, Rita Z. Goldstein, PhD
Department of Psychiatry (primary)
and Department of Neuroscience, Friedman Brain Institute (secondary)
Chief, Neuropsychoimaging of Addiction and Related Conditions (NARC) Research Program

Anna Zilverstand PhD
Assistant Professor, Psychiatry

Icahn School of Medicine at Mount Sinai
The Leon and Norma Hess Center for Science and Medicine
New York, NY 10029 

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

Response: In comparison to previous reviews that often focused on investigating select brain circuits, such as the reward network, our review is the first to systematically discuss all brain networks implicated in human drug addiction. Based on more than 100 neuroimaging studies published since 2010, we found that six major brain networks showed altered brain function in individuals with addiction. These brain circuits are involved in a person’s ability to select their actions (executive network), in directing someone’s attention (salience network), in adaptive learning of new behaviors (memory network), in the automatization of behaviors (habit network), in self-reflection (self-directed network) and the valuation of different options (reward network).

When individuals with addiction are confronted with pictures of drug taking, all of these networks become very highly engaged; however, when the same individuals are confronted with scenes depicting other people, their brains show a reduced reaction as compared to healthy individuals, indicating less involvement. Similarly, the brain of an addicted individual is less engaged when making decisions (that are not relevant to their drug taking) or when trying to inhibit impulsive actions. We further found that some impairments of brain functions, such as alterations underlying the difficulty to inhibit impulsive actions, seem to precede drug addiction, as we observe similar impairments in adolescents that later go on to abuse drugs. However, particularly the impairments in the executive network (involved in the ability to inhibit impulsive actions), the valuation network (which computes the value of an option) and the salience network (that directs attention towards events) seem to be getting worse with more severe drug use and also predict if someone is likely to relapse or not.

The good news is that we also found that it is possible to (partially) recover and normalize brain function in these networks through treatment. Importantly, the widespread alterations of brain function were independent of what drug an individual was addicted to (marijuana, alcohol, cigarettes, cocaine, methamphetamine, heroin, amongst others). Continue reading

Opioid Use Increases Alcohol Relapse Risk

MedicalResearch.com Interview with:

Dr. Katie Witkiewitz PhD Professor, Department of Psychology  University of New Mexico

Dr. Witkiewitz

Dr. Katie Witkiewitz PhD
Professor, Department of Psychology
University of New Mexico

MedicalResearch.com: What are the main findings?

Response: The main findings from our study indicate that individuals with alcohol dependence who misused opioids (e.g., used without a prescription or not as prescribed) had a significantly higher likelihood of relapse to heavy drinking during alcohol treatment and were drinking more alcohol during and following alcohol treatment. Continue reading

American Indian 8th Grade Students Have High Rates of Substance Abuse

MedicalResearch.com Interview with:
Randall C. Swaim, Ph.D.
Senior Research Scientist and Director
Linda R. Stanley, Ph.D.
Senior Research Scientist

Tri-Ethnic Center for Prevention Research
Department of Psychology
Colorado State University                          

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

Response: American Indian adolescents consistently report the highest levels of substance use compared with other US racial/ethnic groups. The harm associated with these high rates of use include higher risk of developing a substance use disorder, more alcohol-related problems, including alcohol-attributable death, and other negative outcomes such as school failure. These findings point to the importance of continuing to monitor this group, particularly given changing trends in perceived harmfulness of illicit substances as new statutes alter access to medical and recreational use of cannabis.

Continue reading

Reducing Opioids Near End of Hospital Stay May Limit Outpatient Use

MedicalResearch.com Interview with:

Jason Kennedy, MS Research project manager Department of Critical Care Medicine University of Pittsburgh

Jason Kennedy

Jason Kennedy, MS
Research project manager
Department of Critical Care Medicine
University of Pittsburgh

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

Response: Most previous studies of opioid use in health care have focused on the outpatient setting. But opioids are often introduced during hospitalization. That’s something clinicians can control, so we looked at inpatient prescription of these drugs to identify targets that may reduce opioid use once patients are out of the hospital.

We analyzed the medical records of 357,413 non-obstetrical adults hospitalized between 2010 and 2014 at 12 University of Pittsburgh Medical Center (UPMC) hospitals in southwestern Pennsylvania. The region is one of the areas of the country where opioid addiction is a major public health problem. We focused on the 192,240 patients who had not received an opioid in the year prior to their hospitalization – otherwise known as “opioid naïve” patients.

Nearly half (48 percent) of these patients received an opioid while hospitalized.  After discharge, those patients receiving hospital opioids were more than twice as likely to report outpatient opioid use within 90-days (8.4 percent vs. 4.1 percent). Patients who receive an opioid for most of their hospital stay and patients who are still taking an opioid within 12 hours of being discharged from the hospital appear more likely to fill a prescription for opioids within 90 days of leaving the hospital.  Continue reading

Can Opioid Users Be Transitioned To Extended-Release Naltrexone?

MedicalResearch.com Interview with:

Dr. Maria Sullivan MD PhD Senior Medical Director of Clinical Research and Development Alkermes

Dr. Sullivan

Maria Sullivan, M.D., Ph.D
Senior Medical Director of Clinical Research and Development
Alkermes

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

Response: Extended release injectable naltrexone is approved for the prevention of relapse to opioid dependence after detoxification and when used with counseling. It is recommended that patients abstain from opioids for a minimum of seven to 10 days prior to induction onto XR-naltrexone to avoid precipitating opioid withdrawal. This requirement of detoxification represents a substantial clinical challenge, particularly in the outpatient setting.

There is currently no single recognized best method for opioid detoxification prior to first dose of extended-release naltrexone (XR-naltrexone). A number of induction regimens have been explored, including the use of low doses of oral naltrexone to shorten the transition period from dependence on opioids to XR-naltrexone treatment. The goal of the study was to help establish an outpatient regimen to transition subjects from physiological opioid dependence to XR-naltrexone treatment and mitigate the severity of opioid withdrawal symptoms.

We hypothesized that low-dose oral naltrexone, combined with buprenorphine and psychoeducational counseling, would assist with the transition of patients with opioid use disorder onto XR-naltrexone. In this 3-arm trial, we examined the utility of oral naltrexone, buprenorphine, and a fixed regimen of ancillary medications (oral naltrexone + buprenorphine vs. oral naltrexone + placebo buprenorphine vs. placebo +placebo), to determine whether any of these regimens was associated with higher rates of induction onto XR-naltrexone.

Continue reading

1000% Increase In Number of Pennsylvania Babies Born Addicted to Opioids

MedicalResearch.com Interview with:

http://www.phc4.org/reports/researchbriefs/neonatal/17/

Joe Martin
Executive Director
PA Health Care Cost Containment Council
Commonwealth of Pennsylvania
Harrisburg, PA 17101

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

Response: Several years ago, our agency noted that while mortality data for opioid addition was being reported, it did not include hospitalizations where death did not occur.  We believed our agency could make a valuable contribution to the data by beginning to report that.  We began with adults hospitalized in PA for opioid addiction, and supplemented that over time with reporting about maternity cases and newborns. Today’s report covers babies born with neonatal abstinence syndrome.

Continue reading

Tamper-Resistant Oxycodone May Have Lead Users To Use Different Opioids

MedicalResearch.com Interview with:

Andrea Schaffer PhD Research Fellow Centre for Big Data Research in Health UNSW Sydney NSW Australia

Dr. Schaffer

Andrea Schaffer PhD
Research Fellow
Centre for Big Data Research in Health
UNSW Sydney NSW Australia 

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

Response: Use and misuse of opioids has increased dramatically in Australia over the past 20 years. In 2014, Australia introduced tamper-resistant controlled-release (CR) oxycodone, which forms a viscous gel when crushed, and is designed to deter its injection or snorting. However, this formulation does not prevent dependence, and can still be misused orally. Tamper-resistant oxycodone CR was also introduced in the US (2010) and Canada (2012), resulting in reductions in oxycodone CR use. However, no large population-level studies have looked at switching behaviour in individuals using oxycodone CR, either in Australia or abroad.

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