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Tag: Drugs and Drug Abuse

  • Rutgers Health Poison Control Expert Available to Discuss CDC Warning About Tianeptine

    Rutgers Health Poison Control Expert Available to Discuss CDC Warning About Tianeptine


    Newswise — Diane Calello, Executive and Medical Director of the New Jersey Poison Control Center,at Rutgers New Jersey Medical School, is available to discuss the Centers for Disease Control and Prevention’s report warning that readily purchased tianeptine products (marketed as “Neptune’s Fix”) might contain synthetic cannabis.

    In the past six months, 20 cases of tianeptine ingestion associated with severe adverse effects, including seizure and cardiac arrest, were reported in New Jersey—a sharp increase from the poison control center’s baseline of two or fewer exposure calls per year.

    The following quotes from Dr. Calello can be used in stories about tianeptine products:

    Although products containing tianeptine can be purchased anywhere from gas stations and convenience stores to smoke shops and online, they are not safe to use and have been linked to an outbreak of poisoning here in New Jersey and across the country.

    Tianeptine, an antidepressant with opioid effects, is a dangerous and addictive ingredient sold illegally as a dietary supplement. This drug is not approved by the FDA for any medical use and has caused life-threatening symptoms in patients who have used these products. This recent outbreak of critically ill patients is a reminder to the public that just because a product is easily purchased in stores and online does not mean it is safe to use and has no associated health risks.

    After seeing an unusual uptick in tianeptine calls to our poison center, we decided to investigate further and had a forensic lab test a few Neptune’s Fix products. Results concluded the presence of two synthetic cannabinoids and other ingredients such as tianeptine, kava, and two plant cannabinoids.

    Unfortunately, misleading labels and hidden ingredients are not uncommon when it comes to supplements. Potentially dangerous interactions with other medicines can cause serious and potentially fatal health effects. Call the Poison Help line at 1-800-222-1222 if you have questions or concerns about a tianeptine product or other medicine or substance. Poison control centers are available 24/7 to provide medical care and guidance.





    Rutgers University-New Brunswick

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  • Some mosquitoes like it hot

    Some mosquitoes like it hot

    Newswise — Certain populations of mosquitoes are more heat tolerant and better equipped to survive heat waves than others, according to new research from Washington University in St. Louis.

    This is bad news in a world where vector-borne diseases are an increasingly global health concern. Most models that scientists use to estimate vector-borne disease risk currently assume that mosquito heat tolerances do not vary. As a result, these models may underestimate mosquitoes’ ability to spread diseases in a warming world.

    Researchers led by Katie M. Westby, a senior scientist at Tyson Research Center, Washington University’s environmental field station, conducted a new study that measured the critical thermal maximum (CTmax), an organism’s upper thermal tolerance limit, of eight populations of the globally invasive tiger mosquito, Aedes albopictus. The tiger mosquito is a known vector for many viruses including West Nile, chikungunya and dengue.

    “We found significant differences across populations for both adults and larvae, and these differences were more pronounced for adults,” Westby said. The new study is published Jan. 8 in Frontiers in Ecology and Evolution.

    Westby’s team sampled mosquitoes from eight different populations spanning four climate zones across the eastern United States, including mosquitoes from locations in New Orleans; St. Augustine, Fla.; Huntsville, Ala.; Stillwater, Okla.; St. Louis; Urbana, Ill.; College Park, Md.; and Allegheny County, Pa.

    The scientists collected eggs in the wild and raised larvae from the different geographic locations to adult stages in the lab, tending the mosquito populations separately as they continued to breed and grow. The scientists then used adults and larvae from subsequent generations of these captive-raised mosquitoes in trials to determine CTmax values, ramping up air and water temperatures at a rate of 1 degree Celsius per minute using established research protocols.

    The team then tested the relationship between climatic variables measured near each population source and the CTmax of adults and larvae. The scientists found significant differences among the mosquito populations.

    The differences did not appear to follow a simple latitudinal or temperature-dependent pattern, but there were some important trends. Mosquito populations from locations with higher precipitation had higher CTmax values. Overall, the results reveal that mean and maximum seasonal temperatures, relative humidity and annual precipitation may all be important climatic factors in determining CTmax.

    “Larvae had significantly higher thermal limits than adults, and this likely results from different selection pressures for terrestrial adults and aquatic larvae,” said Benjamin Orlinick, first author of the paper and a former undergraduate research fellow at Tyson Research Center. “It appears that adult Ae. albopictus are experiencing temperatures closer to their CTmax than larvae, possibly explaining why there are more differences among adult populations.”

    “The overall trend is for increased heat tolerance with increasing precipitation,” Westby said. “It could be that wetter climates allow mosquitoes to endure hotter temperatures due to decreases in desiccation, as humidity and temperature are known to interact and influence mosquito survival.”

    Little is known about how different vector populations, like those of this kind of mosquito, are adapted to their local climate, nor the potential for vectors to adapt to a rapidly changing climate. This study is one of the few to consider the upper limits of survivability in high temperatures — akin to heat waves — as opposed to the limits imposed by cold winters.

    “Standing genetic variation in heat tolerance is necessary for organisms to adapt to higher temperatures,” Westby said. “That’s why it was important for us to experimentally determine if this mosquito exhibits variation before we can begin to test how, or if, it will adapt to a warmer world.”

    Future research in the lab aims to determine the upper limits that mosquitoes will seek out hosts for blood meals in the field, where they spend the hottest parts of the day when temperatures get above those thresholds, and if they are already adapting to higher temperatures. “Determining this is key to understanding how climate change will impact disease transmission in the real world,” Westby said. “Mosquitoes in the wild experience fluctuating daily temperatures and humidity that we cannot fully replicate in the lab.”

    Washington University in St. Louis

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  • Mindfulness Could Help Women with Opioid Use Disorder Better Control Drug Urges

    Mindfulness Could Help Women with Opioid Use Disorder Better Control Drug Urges

    BYLINE: Patti Zielinski

    Newswise — Mindfulness-Oriented Recovery Enhancement (MORE) — a behavioral intervention that integrates training in mindfulness, emotion regulation strategies and savoring of natural rewards — could hold the key to mitigating relapse in women undergoing medically assisted opioid use disorder treatment, a Rutgers study found.

    The pilot study published in the journal Explore, is the first to evaluate the potential neural changes that underlie women’s emotion regulation and craving after an eight-week MORE intervention.

    Previous studies have shown that women report higher opioid craving and show a greater inability to control their drug urges than men. Although medications, like buprenorphine, can be effective in mitigating urges in the short-term by limiting biological changes associated with acute withdrawal, it is less effective at long-term adherence in avoiding relapse with other illicit drugs.

    “While these medications help with withdrawal, they do not fully engage the core regulatory and affective processing circuits that give people control over negative emotion and do not help to address opioid craving in a sustainable way,” said the lead author Suchismita Ray, an associate professor at Rutgers School of Health Professions. “This is where complementary therapies, such as MORE, could play a key role.”

    MORE, which was developed by Eric L. Garland at The University of Utah, is centered on three key therapeutic processes:

    • Mindfulness, which trains a person to become aware of when their attention has become fixated on addictive cues, stressors or pain, then to shift from affective to sensory processing of craving, stress or pain sensations and re-orient their attention through mindful breathing.
    • Reappraisal of thoughts to disengage from negative emotions and addictive behaviors and turn toward positive thoughts that promote resilience, meaning and active coping behaviors.
    • Savoring naturally rewarding experiences (nature, time with a loved one) in a mindful way and recognize the positive emotional responses to the experience.

    Researchers studied nine women in residential treatment who were on medications for opioid use disorder and completed an eight-week MORE intervention once a week for two hours. Both before and after the eight-week period, researchers gave participants an emotion regulation questionnaire and then scanned their brains in a magnetic resonance imaging machine while they listening to a 10-minute guided MORE meditation and viewed a picture of an outdoor garden to measure the brain’s communication during the meditation.

    “Prior studies have shown that the inability to handle negative emotion and drug craving are major determinants of drug relapse. We examined the immediate effects of the 10-minute guided MORE meditation on mood and craving, then looked at the effects of the eight-week MORE intervention on brain communication and how well the women regulated their emotions,” Ray said. “The results show that a single 10-minute guided MORE meditation without any prior meditation experience immediately improved participants’ mood. The eight-week MORE intervention boosted their emotional awareness and strengthened their impulse control — factors that are important in preventing relapse.”

    In addition, researchers found that the eight-week MORE intervention resulted in significantly increased communication between the areas of the brain that may help women with opioid use disorder to better control their negative emotion and drug craving.

    “What this could mean is if an opioid user experiences stress or a craving for an opioid, she can immediately practice a 10-minute MORE meditation, which will improve her mood in the moment and potentially prevent her from taking the drug,” Ray said. “If that person also takes part in the eight-week MORE intervention, she could reap additional long-term benefits to control negative emotion and opioid craving and better maintain sobriety.”

    Other Rutgers authors include Jamil Bhanji and Mauricio Delgado (Rutgers–Newark) and Patricia Dooley Budsock and Nina A. Cooperman (Rutgers Robert Wood Johnson Medical School). Eric L. Garland from The University of Utah is also an author on this pilot study.

    The authors would like to acknowledge The Rutgers University Brain Imaging Center in Newark where the subject scanning took place for this pilot study.

    Rutgers University-New Brunswick

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  • Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

    Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

    Newswise — SAN FRANCISCO — Although people with opioid use disorder (OUD) are significantly more likely to overdose or have a complication after major surgery than those without the disorder, using medications for the treatment of OUD before surgery may eliminate that extra risk, suggests a large, first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Patients with OUD who didn’t use an OUD medication (such as buprenorphine or methadone) were over four times more likely to overdose after having surgery, yet those who used evidence-based OUD medication before surgery were essentially at no greater risk than those who didn’t have OUD, according to the study. Taken orally, OUD medications reduce withdrawal and cravings and prevent opioids from producing the feeling of euphoria that drives addiction.

    “We know that OUD treatments are very effective in helping to prevent relapse, overdose and death in nonsurgical patients, but our research is the first to show that they also may be remarkably effective in at-risk patients facing surgical stress and recovery pain that often is addressed with opioids,” said Anjali Dixit, M.D., MPH, a pediatric anesthesiologist at Stanford University, California. “This is helping us learn more about how to optimally treat OUD patients so that their surgical and post-surgical pain is well-controlled, while also making sure we are minimizing their risk of relapse and overdose.”

    Researchers analyzed 4,030,032 surgeries performed between 2008 and 2020 from the Merative MarketScan Commercial Database, a nationwide sample of data from patients with both employer-sponsored and Medicare Advantage insurance. The analysis reviewed overdoses and other complications (such as OUD-related hospitalization or infection) that occurred in the three months after surgery for the 25 most common surgeries, including knee and hip replacement, hysterectomy and gallbladder removal.

    Of the over 4 million surgeries, 26,827 were performed on patients who had a history of OUD, 9,699 (36%) of whom used OUD medications in the month before surgery and 17,128 (64%) who did not. OUD patients who did not use OUD medications were 4.2 times more likely to overdose or have an OUD-related infection or hospitalization than those who did not have the disorder, according to the study. OUD patients who used OUD medications did not experience a statistically different risk of opioid-related adverse events compared to those who did not have the disorder.

    As many as 7.6 million people in the U.S. live with OUD, according to research, and that number continues to grow. Only 20% of people with OUD currently use OUD medications, said Dr. Dixit. She noted the number of people in the study who used OUD medications was likely higher, because they had access to commercial insurance and therefore, better access to care. The researchers also want to look at other populations such as those on Medicaid, because they may be sicker and have less access to care.

    “The national efforts to increase access to OUD medications is good news for people with OUD, including those who need surgery,” said Dr. Dixit. “The next step is to determine if a particular medication or regimen is better than another.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

    American Society of Anesthesiologists (ASA)

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  • Targeting a coronavirus ion channel could yield new Covid-19 drugs

    Targeting a coronavirus ion channel could yield new Covid-19 drugs

    Newswise — CAMBRIDGE, MA — The genome of the SARS-CoV-2 virus encodes 29 proteins, one of which is an ion channel called E. This channel, which transports protons and calcium ions, induces infected cells to launch an inflammatory response that damages tissues and contributes to the symptoms of Covid-19.

    MIT chemists have now discovered the structure of the “open” state of this channel, which allows ions to flow through. This structure, combined with the “closed” state structure that was reported by the same lab in 2020, could help scientists figure out what triggers the channel to open and close. These structures could also guide researchers in developing antiviral drugs that block the channel and help prevent inflammation.

    “The E channel is an antiviral drug target. If you can stop the channel from sending calcium into the cytoplasm, then you have a way to reduce the cytotoxic effects of the virus,” says Mei Hong, an MIT professor of chemistry and the senior author of the study.

    MIT postdoc Joao Medeiros-Silva is the lead author of the study, which appears today in Science Advances. MIT postdocs Aurelio Dregni and Pu Duan and graduate student Noah Somberg are also authors of the paper.

    Open and closed

    Hong has extensive experience in studying the structures of proteins that are embedded in cell membranes, so when the Covid-19 pandemic began in 2020, she turned her attention to the coronavirus E channel.

    When SARS-CoV-2 infects cells, the E channel embeds itself inside the membrane that surrounds a cellular organelle called the ER-Golgi intermediate compartment (ERGIC). The ERGIC interior has a high concentration of protons and calcium ions, which the E channel transports out of ERGIC and into the cell cytoplasm. That influx of protons and calcium leads to the formation of multiprotein complexes called inflammasomes, which induce inflammation.

    To study membrane-embedded proteins such as ion channels, Hong has developed techniques that use nuclear magnetic resonance (NMR) spectroscopy to reveal the atomic-level structures of those proteins. In previous work, her lab used these techniques to discover the structure of an influenza protein known as the M2 proton channel, which, like the coronavirus E protein, consists of a bundle of several helical proteins.

    Early in the pandemic, Hong’s lab used NMR to analyze the structure of the coronavirus E channel at neutral pH. The resulting structure, reported in 2020, consisted of five helices tightly bundled together in what appeared to be the closed state of the channel.

    “By 2020, we had matured all the NMR technologies to solve the structure of this kind of alpha-helical bundles in the membrane, so we were able to solve the closed E structure in about six months,” Hong says.

    Once they established the closed structure, the researchers set out to determine the structure of the open state of the channel. To induce the channel to take the open conformation, the researchers exposed it to a more acidic environment, along with higher calcium ion levels. They found that under these conditions, the top opening of the channel (the part that would extend into the ERGIC) became wider and coated with water molecules. That coating of water makes the channel more inviting for ions to enter.

    That pore opening also contains amino acids with hydrophilic side chains that dangle from the channel and help to attract positively charged ions.

    The researchers also found that while the closed channel has a very narrow opening at the top and a broader opening at the bottom, the open state is the opposite: broader at the top and narrower at the bottom. The opening at the bottom also contains hydrophilic amino acids that help draw ions through a narrow “hydrophobic gate” in the middle of the channel, allowing the ions to eventually exit into the cytoplasm.

    Near the hydrophobic gate, the researchers also discovered a tight “belt,” which consists of three copies of phenylalanine, an amino acid with an aromatic side chain. Depending on how these phenylalanines are arranged, the side chains can either extend into the channel to block it or swing open to allow ions to pass through.

    “We think the side chain conformation of these three regularly spaced phenylalanine residues plays an important role in regulating the closed and open state,” Hong says.

    Viral targeting

    Previous research has shown that when SARS-CoV-2 viruses are mutated so that they don’t produce the E channel, the viruses generate much less inflammation and cause less damage to host cells.

    Working with collaborators at the University of California at San Francisco, Hong is now developing molecules that could bind to the E channel and prevent ions from traveling through it, in hopes of generating antiviral drugs that would reduce the inflammation produced by SARS-CoV-2.

    Her lab is also planning to investigate how mutations in subsequent variants of SARS-CoV-2 might affect the structure and function of the E channel. In the Omicron variant, one of the hydrophilic, or polar, amino acids found in the pore opening is mutated to a hydrophobic amino acid called isoleucine.

    “The E variant in Omicron is something we want to study next,” Hong says. “We can make a mutant and see how disruption of that polar network changes the structural and dynamical aspect of this protein.”

    ###

    The research was funded by the National Institutes of Health and the MIT School of Science Sloan Fund.

    Massachusetts Institute of Technology (MIT)

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  • Overdose deaths from fentanyl laced stimulants have risen 50-fold since 2010

    Overdose deaths from fentanyl laced stimulants have risen 50-fold since 2010

    EMBARGOED FOR USE UNTIL:

    12:01 a.m. (EDT) on Sept. 14, 2023

     

    Newswise — Overdose deaths from fentanyl laced stimulants have risen 50-fold since 2010

     

    The trend marks the fourth wave in the US overdose crisis, which began with prescription opioid deaths in the early 2000s and has since continued with other drugs

    New UCLA-led research has found that the proportion of US overdose deaths involving both fentanyl and stimulants has increased more than 50-fold since 2010, from 0.6% (235 deaths) in 2010 to 32.3% (34,429 deaths) in 2021. 

    By 2021, stimulants such as cocaine and methamphetamine had become the most common drug class found in fentanyl-involved overdoses in every US state.  This rise in fentanyl/stimulant fatalities constitutes the ‘fourth wave’ in the US’s long-running opioid overdose crisis –the death toll of which continues to rise precipitously. 

    “We’re now seeing that the use of fentanyl together with stimulants is rapidly becoming the dominant force in the US overdose crisis,” said lead author Joseph Friedman, an addition researcher at the David Geffen School of Medicine at UCLA. “Fentanyl has ushered in a polysubstance overdose crisis, meaning that people are mixing fentanyl with other drugs, like stimulants, but also countless other synthetic substances. This poses many health risks and new challenges for healthcare providers. We have data and medical expertise about treating opioid use disorders, but comparatively little experience with the combination of opioids and stimulants together, or opioids mixed with other drugs. This makes it hard to stabilize people medically who are withdrawing from polysubstance use.”

    The findings will be published in the peer-reviewed journal Addiction.

    The analysis illustrates how the US opioid crisis began with an increase in deaths from prescription opioids (wave 1) in the early 2000s and heroin (wave 2) in 2010.  Around 2013, an increase in fentanyl overdoses signalled the third wave.  The fourth wave – fentanyl overdoses with stimulants – began in 2015 and continues to grow.

    Further complicating matters is that people consuming multiple substances may also be at increased risk of overdose, and many substances being mixed with fentanyl are not responsive to naloxone, the antidote to an opioid overdose.  

    The authors also found that fentanyl/stimulant overdose deaths disproportionately affect racial/ethnic minority communities in the US, including Black and African American people and Native American people. For instance, in 2021, the prevalence of stimulant involvement in fentanyl overdose deaths was 73% among 65 to 74-year-old Non-Hispanic Black or African American women living in the western US and 69% among 55 to 65-year-old Black or African American men living in the same area.  The rate among the general US population in 2021 was 49%.

    There are also geographical patterns to fentanyl/stimulant use.  In the northeast US, fentanyl tends to be combined with cocaine; in the southern and western US, it appears most commonly with methamphetamine. 

    “We suspect this pattern reflects the rising availability of, and preference for, low-cost, high-purity methamphetamine throughout the US, and the fact that the Northeast has a well-entrenched pattern of illicit cocaine use that has so far resisted the complete takeover by methamphetamine seen elsewhere in the country,” Friedman said.

    The study was funded by the UCLA Medical Scientist Training Program (National Institute of General Medical Sciences training grant GM008042) and the National Institute on Drug Abuse at the National Institutes of Health (K01DA050771). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    University of California, Los Angeles (UCLA), Health Sciences

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  • New Mental Health Partnership Looks to Explain Biological Factors Behind Substance Use in Adolescents Experiencing Anxiety

    New Mental Health Partnership Looks to Explain Biological Factors Behind Substance Use in Adolescents Experiencing Anxiety

    Newswise — CHAPEL HILL, NC – Anxiety remains one of the most diagnosed clinical symptoms in adolescence and is a potent precursor to and exacerbator of substance use disorder. In their new $3.8-million study entitled “Neurobiological Pathways from Anxiety Symptomology in Early Adolescence to Risk for Adverse Patterns of Substance Use” funded through the National Institute on Drug Abuse, UNC School of Medicine and Frank Porter Graham Child Development Institute at UNC-Chapel Hill researchers will examine the neural and physiological mechanisms associated with emergence of substance use in adolescence who experience anxiety.

    Aysenil Belger, PhD, professor in the UNC Department of Psychiatry and director of the Clinical Translational Core UNC Intellectual and Developmental Disabilities Research Center; and Diana Fishbein, PhD, senior scientist and director of translational neuro-prevention research at the Frank Porter Graham Child Development Institute at UNC-Chapel Hill, are co-principal investigators leading a team of researchers to examine cognitive functions, stress physiology and brain circuits and functions that distinguish adolescents with anxiety who do and do not go on to use psychoactive substances, including alcohol, during adolescence.

    Researchers will recruit children ages 12-14 who report symptoms of anxiety. The cohort will then be stratified based on a tool developed by co-PI Ty Ridenour, PhD, senior research analyst at RTI International and co-PI; the tool focuses on risk factors such as home life, peer influences, cognitive functioning, impulsivity, risk-taking, and other behaviors to determine if the child has the individual profile that places them at risk of transitioning to substance use. Researchers will compare brain function and stress physiological systems in adolescents who do and do not initiate substance use over five years.

    This longitudinal study is testing participants at baseline,12 months and 24 months. Adolescents will be studied using magnetic resonance imaging (MRI) while performing tasks that measure cognitive control, impulsivity, and executive decision-making. Their physiological responses to social stressors, including heart rate, perspiration, and changes in the stress hormone, cortisol, will also be measured. In-depth surveys and toxicology screens are used to determine substance use patterns and a wide range of other child characteristics. The first goal is to first identify the predictors of adverse patterns of substance use in adolescents with anxiety symptoms and, second, to determine what neurobiological mechanisms drive this association. This information will enable the development of more targeted, personalized interventions to prevent pathways of substance use.

    “We have very little understanding of the biological differences that explain why some people are prone to substance use or why some children and adolescents get to the point of substance use while others don’t,” Belger said. “Once we find these biological markers, we can identify those at increased risk and what the risk factors are for that individual, and we can develop interventions that enhance cognitive skills or intervene with stress management to keep them off the adverse trajectory, using prevention science.”

    Fishbein said, “When young people experience anxiety symptoms, it can compromise the ability of interventions to prevent substance use from developing. In adding to our knowledge about biological processes that underlie anxiety and how they relate to substance use, this study will help us to identify windows of opportunity during child and adolescent development when we can most effectively intervene.”

    Although this study focuses on biological “risks” that may propel youth toward substance use, the researchers will also identify protective factors, such as strong connections between cognitive and emotional centers of the brain or supportive social networks that may reduce risk and lead to more positive outcomes for children with anxiety.

    Given that a child’s brain is very sensitive to early experiences, identifying conditions that have positive effects should reveal opportunities for strengthening those protective factors to avoid pathways to negative outcomes.

    “This research is timely and important,” Belger added. “Post-pandemic anxiety and mental health issues in adolescents are on the rise, and many of the same characteristics we’re studying also contribute to other mental health issues like suicidality. Our study results could identify more than just risk for substance use. There are policy implications as well, including identifying social, structural, and systemic risk factors that contribute to anxiety and substance use.”

    Belger, who had directed the Frank Porter Graham Child Development Institute (FPG) for five years, is focused on understanding neurobiological systems, functions and mechanisms that contribute to the development of psychopathology in youth. She works on the biology of high-risk integrating multimodal methodologies such as brain imaging, electrophysiological recordings, and cognitive behavioral assessments.

    Fishbein’s career has centered on understanding factors that contribute to the development of psychopathology, focusing on adverse experiences that predict negative outcomes, including substance abuse. She is particularly interested in how evidence-based interventions and policies have the potential to normalize developmental trajectories, leading to positive behavioral and mental health outcomes.

    Ridenour’s groundbreaking work focuses on translating problem behavior etiology research into clinical tools to improve prevention integrating advanced statistical analysis for longitudinal clinical trials.

    Together, the work of Belger, Fishbein, and Ridenour applies technologies and findings from neuroscience to address outstanding questions in the field of prevention, leading to more effective methods and policy reforms to support the health and well-being of our young people.

    The researchers want to bridge with other collaborators studying brain function in adolescents in other circumstances. The team is excited to hear from others who want to add measures to ancillary projects. The researchers are also interested in clinical collaborations for recruitment but also for referral of vulnerable children. To join the collaboration to become a resource for psychoeducation for families, reach out to Aysenil Belger.

    UNC Psychiatry contact: Samantha Weiss

    UNC School of Medicine contact: Mark Derewicz

    University of North Carolina School of Medicine

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  • Fatal overdoses rise after drug seizure, study finds

    Fatal overdoses rise after drug seizure, study finds

    Newswise — PROVIDENCE, R.I. [Brown University] — For decades, efforts by police to seize illicit drugs have been a cornerstone strategy for disrupting drug markets and removing drugs from communities. But there’s an unintended outcome when opioids are seized, a new study finds — increases in overdoses, including those that are fatal.

    The study found that police drug seizures were associated with increases in fatal overdose in the surrounding geographic area in the three weeks following enforcement, possibly by leading people with substance use disorder to take greater risks when they tried to restore their supply. The study, published in the American Journal of Public Health, raises questions about policies that might be exacerbating overdoses during a persistent epidemic that is contributing to reductions in the nation’s life expectancy.

    The findings provide evidence that efforts to disrupt drug markets can have unintended effects in generating public harm, said Bradley Ray, a senior researcher at the nonprofit research institute RTI International who led the study. 

    “It’s concerning to think routine drug enforcement can exacerbate harms, so we need to focus on mitigating these sources of overdose risk,” Ray said. 

    Brandon del Pozo, an assistant professor (research) at Brown University’s Warren Alpert Medical School and School of Public Health, co-authored the study. Del Pozo spent 19 years at the New York City Police Department and four years as chief of police of Burlington, Vermont, where he directed the city’s response to the opioid crisis. The study highlighted the “collateral consequences” of law enforcement seizures of drugs, del Pozo said.

    “To be truly effective in reducing overdose deaths, policing strategies need to be comprehensive,” he said. “That means taking into account all the outcomes of police work, not just the effect of incapacitating drug dealers, but also how seizing drugs disrupts sales in a community, and how those disrupted sales affect usage patterns, and how those usage patterns affect an individual’s health and safety. According to this study, we have evidence that seizing opioids increases exposure to overdose.”

    To conduct the study, the research team used two years of administrative data from Marion County, Indiana, to compare different types of drug seizures with subsequent changes in fatal overdoses, nonfatal overdose calls for emergency medical services and naloxone administration in the surrounding area.

    They found that within seven, 14 and 21 days, opioid-related seizures of drugs by police were significantly associated with increased overdoses within 100, 250 and 500 meters of the seizure location. Most notably, the number of fatal overdoses was two-fold higher than expected within seven days and 500 meters following an opioid-related incident in which police seized drugs.

    The researchers hypothesized that the increase in overdose events was because people who use opioids will generally seek out a new supply after losing access to their previous drug supply, and that new supply will have unknown potency. In addition, in the time period between losing the familiar supply and finding a new one, people using opioids can experience diminished tolerance to drugs. Accidentally ingesting a dose beyond one’s tolerance can be fatal.

    “One of the risks of the illicit drug market is uncertainty about what constitutes a safe dose,” Ray said. “If people who use drugs lose access to their usual supply, they are forced to find an unknown supplier, which introduces uncertainty about what is in the drugs they procure, thereby increasing overdose risk.”

    Fentanyl — a highly potent opioid often used to lace other heroin or cocaine that has come to dominate the illicit opioid market — is driving the fatality count in opioid- and stimulant-involved overdose deaths, the researchers noted. Much of the drug supply is now contaminated by fentanyl, which is lethal even in small doses.

    “The ubiquity of fentanyl in the drug supply affords people who use drugs almost no margin of error if they make a dosing mistake,” del Pozo said.

    The study findings, del Pozo said, can inform a more effective law enforcement strategy for preventing overdoses. For example, he said that it’s important to ensure that a drug seizure in a particular area is also accompanied by targeted harm reduction approaches such as outreach services, links to treatment, increased naloxone distribution and programs that test illicit drugs for the presence of fentanyl.

    “If the seizure of drugs by law enforcement is going to continue to be a part of the strategic response to the country’s overdose crisis, then it has to take into the account that at least in the short term, seizing drugs increases overdoses,” del Pozo said. “Part of the mission of drug enforcement is to save lives, and with the current approach, it’s doing the opposite.”

    Other study contributors included Steven J. Korzeniewski, Grant Victor, Philip Huynh and Bethany J. Hedden from Wayne State University; George Mohler from Boston College; and Jennifer J. Carroll from the Warren Alpert Medical School at Brown University and North Carolina State University.

    The study was funded by the U.S. Centers for Disease Control and Prevention.

    Brown University

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  • Penn Medicine to Open New Crisis Response Center as Part of a Unified Mental Health Care Hub at Hospital of the University of Pennsylvania – Cedar Avenue

    Penn Medicine to Open New Crisis Response Center as Part of a Unified Mental Health Care Hub at Hospital of the University of Pennsylvania – Cedar Avenue

    Newswise — PHILADELPHIA—Penn Medicine is launching a new community mental health hub at the Hospital of the University of Pennsylvania — Cedar Avenue (HUP Cedar), co-locating inpatient and outpatient psychiatric care with a new crisis response center (CRC) at the facility. The multi-year plan will put crucial psychiatric and substance use care in easy reach for West and Southwest Philadelphia residents, at a time when both mental illness and drug and alcohol dependence are surging in the city.

    The project will begin with moving inpatient psychiatric and drug and alcohol detoxification units from Penn Presbyterian Medical Center to HUP Cedar in July, followed by the opening of a new crisis response center at the facility later in the summer which is expected to provide an estimated 4,000 patient visits each year. The steps will create two comprehensive, fully integrated mental health hubs at Penn Medicine facilities in Philadelphia, offering emergency mental health services and inpatient and outpatient care at both HUP Cedar and Pennsylvania Hospital, which has operated a CRC since 1999. Together, Pennsylvania Hospital and HUP Cedar will have 73 licensed inpatient psychiatric beds and 16 beds for substance use treatment. Additional space at HUP Cedar will allow for expansion of coordinated services to further care for West and Southwest Philadelphia communities over the next five years.

    “The COVID-19 pandemic accelerated the mental health crisis across the nation. As COVID recedes, we have a moral imperative to tackle this suffering in our communities,” said Kevin B. Mahoney, chief executive officer of the University of Pennsylvania Health System (UPHS). “Providing easy access to care when people are in crisis changes – and saves – lives. We are committed to the investment and innovation needed to close the gaps in access to care and reverse the toll of mental health and substance use in Philadelphia.”

    As one of the nation’s largest cities, Philadelphia’s mental health struggles are a microcosm of broader trends: A Pew Research Center survey from late 2022 reported that 41 percent of Americans — and nearly 60 percent of young adults — have experienced high levels of psychological distress at least once since the early stages of the pandemic. At the same time, more than two-thirds of Americans live in areas without sufficient psychiatrists and other mental health professionals. In Philadelphia, more than 20 percent of the city’s residents are coping with a diagnosed depressive disorder and substance use-related deaths have climbed to record levels.

    Similar to the CRC at Pennsylvania Hospital, the HUP Cedar CRC — which will replace the CRC previously operated on the site by Mercy Philadelphia Hospital until its closure in March of 2020 — will be licensed as a crisis intervention walk-in facility and will serve as a discreet psychiatric emergency room, providing triage, evaluation, treatment and social services support for acute substance use and serious psychiatric conditions such as bipolar disorder, major depression, anxiety disorders, and schizophrenia.

    The co-location of the inpatient psychiatric units with emergency care provided through the CRC will enable a seamless transition of care for patients, eliminating the wait time and additional steps required to transfer patients to inpatient units at other facilities — a common occurrence in a city where emergency psychiatric resources remain in short supply.

    “We know that a lack of quality mental health support and crisis response services has a traumatic ripple effect across families and entire communities. When patients and families are coping with a mental health crisis, the last thing they need to think about is how to navigate a complex system,” said UPHS Chief Operating Officer Michele Volpe. “By putting all our services together, we can help keep patients safer, get them into treatment faster, and better support families as they begin to navigate supporting their loved ones during their hospitalization and recovery.”

    Staff at both CRC locations will be connected via a real-time data system providing details on bed availability in order to ensure patients can be placed as quickly as possible and that each location has the right staffing resources. Penn Presbyterian will continue to provide select outpatient psychiatric care as well treatment for substance use disorders after the transition of inpatient services to HUP Cedar.

    HUP Cedar is part of the PHMC Public Health Campus on Cedar, which opened in March 2021, transitioning the building from the former Mercy Philadelphia Hospital into a campus offering emergency and inpatient care as well as primary care and community-driven social supports.

    Penn Medicine will invest $5.76M toward the opening of the CRC at HUP Cedar as part of the mental health hub project. The CRC reopening has also received funding from the Independence Blue Cross Foundation, and the City of Philadelphia Department of Behavioral Health earmarked $4.1 million in HealthChoices reinvestment funds.

    In addition to Penn Medicine’s adult mental health services on the site, Children’s Hospital of Philadelphia plans to open an inpatient pediatric behavioral health facility, the CHOP Behavioral Health & Crisis Center, on the site, as well. The 46-bed acute inpatient psychiatric facility and 24/7 walk-in crisis center will create a safe, inclusive and restorative setting for children and adolescents.

    The second phase of the new mental health hub plan will also increase care capacity at Penn Presbyterian Medical Center (PPMC), by converting the vacated psychiatric beds to medical surgical units. Those steps will help to improve patient movement across the hospital, reducing emergency department wait times and providing additional capacity for post-surgery recovery.

    The new services at HUP Cedar are part of Penn Medicine’s wraparound commitment to bringing more mental health care support to the community across each of its mission areas. Penn Integrated Care (PIC), a program, which embeds mental health professionals in primary care practices, launched in 2018. More than 230,000 patients in 24 Penn Medicine primary clinics have access to PIC services. To date, 35,000 patients have been treated directly by PIC clinicians or connected to specialty care in the community.

    Beginning this summer, the health system will add a new path for training fellows in drug and alcohol use treatment. That program, for physicians specializing in family medicine, primary care, and emergency medicine, among other disciplines, aims to ensure that providers in multiple settings are equipped to help patients take steps toward recovery and provides a much-needed addition to the existing fellowship in Addiction Psychiatry at Penn Medicine and the Corporal Michael J. Crescenz Veterans Affairs Medical Center (CMC VAMC) in Philadelphia.

    In addition, a new consultation service provides psychiatric care to patients hospitalized for complex medical needs at the Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Penn Presbyterian Medical Center. Future plans include potential opening of a medical-psychiatric unit to ensure that patients with these complex needs are cared for in dedicated spaces.

    “Expanding our resources to care for mental health needs in Philadelphia is a core part of our mission,” said Hospital of the University of Pennsylvania CEO Regina Cunningham, PhD, RN. “No matter where people live in the city, we aspire to provide them with support in convenient settings, and work to erase both the stigmas and access problems that stand in the way of helping people get help.”

    Perelman School of Medicine at the University of Pennsylvania

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  • Cannabis use disorder and schizophrenia connection: expert says the drug, “seems to be amplifying some of the consequences that we are seeing”

    Cannabis use disorder and schizophrenia connection: expert says the drug, “seems to be amplifying some of the consequences that we are seeing”

    What: A new study in Psychological Medicine found an association between young men with cannabis use disorder and a higher risk of developing schizophrenia. Furthermore, intense cannabis use may trigger and/or worsen schizophrenia. 

    Who: Katharine Sperandio, Ph.D., LPC, ACS, NCC, assistant professor of Clinical Mental Health Counseling at Saint Joseph’s University, actively serves clients in the Philadelphia community so that she can continue to use her clinical experiences to inform her teaching and scholarship. The mission of her research agenda is to increase understanding on how to help those living with addiction promote and sustain their recovery and how to optimally support families who are impacted by addiction.

    Dr. Sperandio says this study provides further evidence about some of the potentially deleterious consequences that can come from long-term cannabis use.

    “I think the study reinforces the notion that this is an issue that continues to remain relevant and needs further exploration so that mental health professionals can be better prepared to help those who are using cannabis and have a co-occurring mental health disorder,” says Sperandio.

    “Cannabis has clearly become more potent over time which seems to be amplifying some of the consequences that we are seeing,” says Sperandio. “As a professional counselor and a counselor educator, it is my ethical responsibility to stay up-to-date on the current research so I can educate both my clients and students appropriately.”

    When: Zoom/phone/in-person interview available upon request.

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    About Saint Joseph’s University

    Founded in 1851 as Philadelphia’s Jesuit university, Saint Joseph’s University prepares students for a rapidly changing world by focusing on academic excellence and courageous exploration. With an intellectual tradition distinguished by a foundational liberal arts core and diversified by strong professional programs in education, business, health and science, Saint Joseph’s students are empowered, challenged and supported by high-quality faculty members to follow their own path. As a comprehensive university, undergraduate and graduate students study in the University’s four schools and colleges — the College of Arts and Sciences, the Erivan K. Haub School of Business, the School of Education and Human Development and the School of Health Professions. With academic offerings in the most sought-after majors, including leading programs in the first-in-the-nation Philadelphia College of Pharmacy, nearly 100% of students are employed, pursuing advanced degrees or volunteering in prestigious service programs upon graduation. The University’s network of nearly 100,000 proud alumni keep alive the rallying cry — The Hawk Will Never Die.

    Saint Joseph’s University

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  • Gun violence spills into new neighborhoods as gentrification displaces drug crime

    Gun violence spills into new neighborhoods as gentrification displaces drug crime

    Newswise — Gentrification doesn’t erase drug crime and gun violence. Instead, research from West Virginia University economist Zachary Porreca shows that when one urban block becomes upwardly mobile, organized criminal activity surges outward to surrounding blocks, escalating the violence in the process.

    Porreca, a WVU doctoral student in the John Chambers College of Business and Economics, analyzed 2011-2020 data on shootings and real estate across various Philadelphia neighborhoods. His paper presenting the findings, published in the Journal of Economic Behavior and Organization, is one of the first of its kind to study the impact of gentrification on crime displacement.

    “Over the 10-year window of the study, Philadelphia experienced some 5,800 shootings that can be attributed to gentrification,” Porreca said. “That means that of the 27,000 shootings that occurred across the city during that decade, almost a quarter may have been spillover effects of gentrification.

    “Gentrification increases levels of gun violence in neighbor blocks, even more so when the gentrified block itself has a history of drug crime. There’s an average increase of nearly nine shootings in the surrounding neighborhood, or an 18% increase in gun violence on blocks linked to gentrified blocks, as drug crime that existed on a block pre-gentrification is pushed into the surrounding neighborhood by the new development.”

    The gentrification of drug blocks specifically, as opposed to all gentrifying blocks in Philadelphia, accounted for roughly 2,400 additional shootings during the 10 years of his study. This suggests that some 8% of Philadelphia’s gun violence can be attributed to gentrification destabilizing the city’s illicit drug markets.

    “Those numbers are a striking representation of why it’s crucial that urban development occur responsibly and intentionally,” Porreca said. “Forced displacement of priced-out residents has very real effects on the surrounding neighborhoods.”

    Porreca described gentrification as a “destabilizing force that happens when new residents of higher socioeconomic standing move to a traditionally lower-income neighborhood. Gentrified neighborhoods grow wealthier, more educated, exhibit higher rates of home ownership and experience significant racial demographic changes. This process involves replacing many of the original residents, and that makes it more difficult for a criminal organization to operate openly. Gentrification also leads to increased policing and more punitive policing practices, and overall makes a block less suitable for drug competition.”

    Porreca emphasized that a criminal organization displaced in this way won’t want to go far. Those with that organization will look for new territory within the immediate surrounding blocks that have not yet begun gentrifying, because the local area is proven to be capable of sustaining drug activity and “because the organization has the requisite local knowledge, some level of community support and access to a proven clientele.”

    His research uses data related to shootings, income, housing, home sales and building, zoning and renovation permits to examine gentrification’s effect on crime rates on a city’s “frontiers,” blocks that are newly gentrifying. It shows how gentrification and rapid urban development change the urban landscape of a city, as the emergence of new amenities and residents in traditionally neglected neighborhoods causes the shrinking and reshaping of drug markets’ boundaries, escalating competition and violence.

    Gentrification not only constitutes a “shock” to the total viable territory available to rival criminal organizations, bringing them into closer proximity with each other, but it also spurs gun violence by forcing intracity migration — “displacing residents from their long-term homes and forcing them into the remaining viable tracts of affordable housing,” Porreca said. 

    “As an anecdotal example, a friend whose neighborhood became one of Philadelphia’s trendiest areas told me that his family now lives on the same blocks with families from neighborhoods his original neighborhood once feuded with. These sorts of situations, where disaffected low-income residents are forced to live in unfamiliar neighborhoods surrounded by similarly disaffected and displaced neighbors, have the potential to cause excessive tension. That that can give rise to explosions in gun violence isn’t surprising.”

    Porreca suggested that police resources could be utilized in the neighborhoods surrounding newly developed blocks.

    “City policy may benefit from efforts to stave off the violent spillover effect through deployment of officers and social workers in areas experiencing significant population displacements,” Porreca said. “Those displacements give rise to volatility and violence, and if we want to prevent community violence, then resources should be deployed proactively alongside the forces of development.”

    West Virginia University

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  • Substance use disorder expert available for comment

    Substance use disorder expert available for comment

    According to the U.S. Department of Health and Human Services, 13.5% of young adults aged 18 to 25 had both a substance use disorder and some form of mental illness in 2021. 

    Lokesh Shahani, MD, PhD, associate professor of psychiatry and behavorial sciences at McGovern Medical School at UTHealth Houston, has done extensive research on substance use disorder. 

    Shahani’s research and clinical background includes substance use, HIV psychiatry, addiction, adult general psychiatry, and geriatric psychiatry. He is board certified by the American Board of Internal Medicine, the American Board of Psychiatry and Neurology, and the American Board of Internal Medicine. He has over 45 publications in peer-reviewed journals and presented his work nationally.

    To arrange an interview contact:

    University of Texas Health Science Center at Houston

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  • New study reveals ketamine could be effective treatment for cocaine-use disorders

    New study reveals ketamine could be effective treatment for cocaine-use disorders

    Newswise — CLEVELAND—As cocaine use continues to climb across the United States, scientists have struggled to develop an effective pharmacological approach to treat the devastating disorder.

    But by seamlessly combining artificial intelligence (AI), human intelligence, clinical testing and computer analysis, researchers at Case Western Reserve University have unearthed an existing option that appears to hold promise.

    “Ketamine, a small synthetic organic molecule used clinically as an anesthetic and a depression treatment, was found to be associated with significant improvement in remission among people with cocaine-use disorders,” said the study’s corresponding author Rong Xu, professor of biomedical informatics and founding director of the Center for AI in Drug Discovery at the Case Western Reserve School of Medicine.

    “This study is a great example of addressing an intractable problem by the creative use of AI using different sources of data,” said study coauthor Pamela Davis, the Arline and Curtis Garvin Research Professor at the School of Medicine. “It is our hope that this approach will suggest therapeutic approaches for other difficult problems.”

    The study, funded by the National Institute on Drug Abuse Clinical Trial Network, was published online today in the journal Addiction.

    More than 2 million people in the U.S. regularly use cocaine, more than three times the number who take methamphetamine. Roughly one of every five drug overdose deaths in this country involves cocaine, and its consistent use contributes to an array of serious health issues—including heart attack and stroke. However, there is no U.S. Food and Drug Administration (FDA)-approved treatment for cocaine-use disorders.

    Decades of research have found that existing medications such as antidepressants or stumulants have no meaningful effect, while others involve such small patient samples as to be years away from certain conclusions. Therapeutic interventions have yielded positive outcomes, but barriers such as cost, staffing and stigma significantly limit widespread adoption.

    By developing novel AI-based drug discovery algorithms to identify promising candidates from all FDA-approved drugs, reviewing top drug candidates by expert panels of  addiction experts such as the University of Cincinnati’s T. John Winhusen, Xu and her colleagues deterimined ketamine held the greatest potential to yield useful insights.

    They evaluated the potential clinical effectiveness of ketamine on improving remission rates among patients with cocaine-use disorders by analyzing tens of millions of electronical health records. They found that cocaine-use disorder patients administered ketamine for pain or depression experienced two to four times higher remission rates.

    While a few previous studies have found increased efficacy of ketamine in treating cocaine use disorder, the groups involved were largely homogenous. The Case Western Reserve study not only included greater diversity of participants by race and gender, but also those suffering from additional medical and psychiatric conditions.

    While this study substantially strengthens the argument for the use of ketamine in treating cocaine-use disorder, the researchers emphasized that additonal clinical trials are required to assess ketamine’s potential impact more thoroughly.

    The work was conducted at the Center for AI in Drug Discovery by research associate ZhenXiang Gao and medical school student Maria Goreflo, in collaboration with Davis, Winhusen, David Kaelber from MetroHealth and Case Western Reserve and Udi Ghitza from the National Institute on Drug Abuse Clinical Trial Network

    The Center for AI in Drug Discovery’s goal is to develop an integrated drug-discovery pipeline driven by advanced AI technologies, preclinical testing in collaboration with biomedical researchers and clinical studies using patient electronic health records.

                                                                ###

                                                               

    Case Western Reserve University is one of the country’s leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 5,800 undergraduate and 6,300 graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible.

     

    Case Western Reserve University

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  • Cannabis-Related Emergency Department Visits among Older Adults on the Rise

    Cannabis-Related Emergency Department Visits among Older Adults on the Rise

    Newswise — As a growing number of older adults are experimenting with cannabis to help alleviate chronic symptoms, a new University of California San Diego School of Medicine study has identified a sharp increase in cannabis-related emergency department visits among the elderly.

    The study, published Jan. 9, 2023 in the Journal of the American Geriatrics Society, identified a 1,808% relative increase in the rate of cannabis-related trips to the emergency department among California adults ages 65 and older from 2005 to 2019. Researchers used a trend analysis of data from the Department of Healthcare Access and Information and found that cannabis-related emergency department visits went from a total of 366 in 2005 to 12,167 in 2019.

    The significant increase is particularly troublesome to geriatricians, given that older adults are at a higher risk for adverse health effects associated with psychoactive substances, including cannabis.

    “Many patients assume they aren’t going to have adverse side effects from cannabis because they often don’t view it as seriously as they would a prescription drug,” said Benjamin Han, MD, MPH, the study’s first author and a geriatrician in the Division of Geriatrics, Gerontology, and Palliative Care in the Department of Medicine at UC San Diego School of Medicine.

    “I do see a lot of older adults who are overly confident, saying they know how to handle it — yet as they have gotten older, their bodies are more sensitive, and the concentrations are very different from what they may have tried when they were younger.”

    The use of cannabis by older adults has increased sharply over the past two decades in the United States with the legalization for medical and recreational purposes in many states. California legalized medical marijuana in 1996 and recreational cannabis in 2016. While there is limited evidence that cannabis may be helpful for specific conditions, older adults are increasingly using the plant-based drug to treat a wide range of symptoms and using it socially — while their perceived risk of regular use is decreasing.

    The study highlights that cannabis use among older adults can lead to unintended consequences that require emergency care for a variety of reasons. Cannabis can slow reaction time and impair attention, which may lead to injuries and falls; increase the risk for psychosis, delirium and paranoia; exacerbate cardiovascular and pulmonary diseases and interact with other prescription medications.

    “We know from work in alcohol that older adults are more likely to make a change in substance use if they see that it is linked to an undesirable medical symptom or outcome — so linking cannabis use similarly could help with behavioral change,” said Alison Moore, MD, MPH, co-author of the study and chief of the Division of Geriatrics, Gerontology, and Palliative Care in the Department of Medicine at UC San Diego School of Medicine.

    “We truly have much to learn about cannabis, given all the new forms of it and combinations of THC (tetrahydrocannabinol) and CBD (cannabidiol), and this will inform our understanding of risks and possible benefits, too.”

    The study highlights that education and discussions with older adults about cannabis use should be included in routine medical care. Yet, according to Moore, current substance uses screening questionnaires typically lump cannabis/marijuana with non-legal drugs, such as cocaine and methamphetamine, which can lead to patients being hesitant to answer.

    “Instead, asking a question like, ‘Have you used cannabis — also known as marijuana — for any reason in the last 12 months?’ would encourage older adults to answer more frankly,” Moore said.

    “Providers can then ask how frequently cannabis is used, for what purpose — such as medically for pain, sleep, or anxiety or recreationally to relax — in what form (smoked, eaten, applied topically) and if they know how much THC and CBD it contains. Once the provider has this type of information, they can then educate the patient about potential risks of use.”

    “Although cannabis may be helpful for some chronic symptoms, it is important to weigh that potential benefit with the risk, including ending up in an emergency department,” Han said.

    Interestingly, the study found while emergency department visits increased sharply between 2013 and 2017, they leveled off in 2017 after the implementation of Proposition 64. The availability of recreational cannabis does not appear to correlate with a higher rate of cannabis-related emergency department visits among older adults.

    Co-authors of the study include Jesse Brennan, Mirella Orozco and Edward Castillo, all with UC San Diego.

    This research was funded, in part, by the National Institute on Drug Abuse (K23DA043651).

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    UC San Diego Health

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  • Study suggests one solution to America’s opioid epidemic: Tell doctors their patients fatally overdosed

    Study suggests one solution to America’s opioid epidemic: Tell doctors their patients fatally overdosed

    Newswise — There are no simple solutions to America’s deadly overdose epidemic, which costs 100,000 lives each year and is erasing gains in life expectancy. But a team of USC researchers have found one low-cost intervention can make a difference: a letter notifying providers their patient has died from an overdose.

    A 2018 study by the team found that notifying clinicians through an informational letter from their county’s medical examiner that a patient had suffered a fatal overdose reduced the number of opioid prescriptions they wrote over the next three months. The team’s new study, published today in JAMA Network Open, shows those notifications have a lasting impact up to a year later.

    “Clinicians don’t necessarily know a patient they prescribed opioids to has suffered a fatal overdose,” said lead author Jason Doctor, Chair of the Department of Health Policy and Management at the USC Sol Price School of Public Policy and Co-Director of the Behavioral Sciences Program at the USC Schaeffer Center for Health Policy & Economics. “We knew closing this information loop immediately reduced opioid prescriptions. Our latest study shows that change in prescribing behavior seems to stick.”

    A simple public health intervention with a lasting impact

    Doctor and his team sent letters to 809 clinicians—predominantly medical doctors—who had prescribed opioids to 166 people who had suffered fatal overdoses in San Diego County. The letter was intended to be informative and respectful in tone while providing information about safer prescribing. The researchers compared prescribing patterns among these clinicians to those who had not received the letter.

    While there was a gradual reduction in opioid prescribing across the board, study authors found the rate of the reduction was faster and more robust among those who received the letter. After one year, those who received the letter wrote 7% fewer prescriptions than clinicians who hadn’t received the notification.

    “The new study shows this change is not just a temporary blip and then clinicians went back to their previous prescribing,” said Doctor. “This low-cost intervention has a long-lasting impact.”

    Doctor acknowledged that attention to the number of deaths from drugs prescribed by clinicians has been eclipsed by the focus on rising deaths from illicit opioid use, particularly during the COVID-19 pandemic.

    “The sad truth is, we never addressed the first problem of deaths from prescribed opioids. In fact, it’s all mixed together because nationally, approximately half of people who die of an illicit fentanyl drug overdose have also had an opioid prescription within the past year,” he explained.

    Medical examiners are uniquely positioned to mitigate future opioid overdose deaths

    The big takeaway, said Doctor, is the letters from the medical examiner provide a unique opportunity to get into communication with physicians in the wake of overdose deaths to save lives from both legal and illegal opioids.

    “The letter is a nudge to providers that the opioid epidemic is in their community and affecting their patients. It is easy to read the headlines and assume you are not part of the problem,” said Doctor. “Doctors have an opportunity to talk to their patients and consider alternatives to opioids. I believe we can reach about half of the people in the illicit fentanyl epidemic through a doctor who has seen them.”

    Doctor and other study authors are currently partnering with Los Angeles County on lessons from the research and looking at potential public policy interventions, including mandating such notifications from county medical examiners to clinicians.

    About the study

    Additional study authors include Emily Stewart and Tara Knight of the USC Schaeffer Center; Roneet Lev of the Scripps Mercy Hospital San Diego; Jonathan Lucas of the Department of Medical Examiner-Coroner of the County of Los Angeles; Andy Nguyen of Global Blood Therapeutics, South San Francisco; and Michael Menchine of the Department of Emergency Medicine at UCLA. The work was supported by the California Health Care Foundation (grant 19413) to Doctor, Stewart and Knight; the National Institute on Aging (NIA) at the National Institutes of Health (grants R21-AG057395-01 and R33-AG057395 to Knight); National Institute on Drug Abuse (R01 DA046226) and the NIA Roybal Center for Behavioral Interventions (P30AG024968 to Knight).

    University of Southern California (USC)

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  • COVID lockdown did not lead to a rush on opioid prescriptions

    COVID lockdown did not lead to a rush on opioid prescriptions

    Newswise — While some feared that New Yorkers would re-fill prescriptions to stockpile opioid medications in the early weeks of the COVID-19 lockdown much in the way people hoarded toilet paper, in fact, New York State opioid prescriptions declined in the period around the March 20, 2020 “PAUSE” order, according to new research. Meanwhile, prescriptions for medications for opioid use disorder (MOUD) were steady, likely thanks to policies to ensure their availability during the same period.

    The study was led by researchers at Columbia University Mailman School of Public Health and appears in the journal Addiction, the journal of the Society for the Study of Addiction.

    The researchers used a database from the health information technology and clinical research company IQVIA to examine trends in the dispensing of opioid prescriptions as New York State implemented various emergency policies to prevent the spread of COVID-19. These orders included pharmacy guidance permitting early refills of controlled and non-controlled medications (March 7); a suspension of elective surgeries in New York City (March 16); and a “New York State on PAUSE” order that greatly reduced trips outside the home (March 20). A concern with the recommendation for patients to refill their prescriptions early was that it would increase the quantities of opioids in households and increase the risk of opioid misuse and overdose. During the same period, the Substance Abuse and Mental Health Services Administration initiated a series of policy responses to support access to MOUD, such as expanding telemedicine and allowing online prescribing of buprenorphine.

    They found that prescriptions for non-MOUD opioids steadily declined between the weeks of March 21 and April 17 with only a small transient increase in early refills. The morphine milligram equivalents/day (MME/day) prescribed were 17 percent lower than in the four weeks before March 21—almost entirely due to a drop in opioids dispensed for prescriptions of a week or less, suggesting the driving cause was the suspension of elective surgeries. (Another possible explanation is reduced demand for opioids related to a decline in accidents and injuries during the lockdown period.) There was no discernable drop in MOUD dispensing associated with the period of the Emergency Orders with only a slight increase in the count of dispensed prescriptions in the week of March 14. These trends were evident statewide, with no disparities between ZIP codes with higher or lower poverty rates.

    The findings are in line with an earlier study that found the lockdown Texas similarly did not lead to a spike in prescriptions for non-MOUD opioids.

    “Our findings add to the evidence showing that the pandemic emergency orders did not cause a mass surge in dispensing of opioids and policy initiatives to ensure access to medications for opioid use disorder were likely effective,” says Andrew Rundle, DrPH, professor of epidemiology at Columbia University Mailman School of Public Health. “The research suggests that critical access to treatments for opioid use disorder can be maintained during future emergency ‘stay at home’ type orders and such orders are unlikely to cause mass early refills of opioid prescriptions and heightened risk of misuse.”

    The study’s first author is Abhinav Suri, who conducted the research as an MPH student in epidemiology at Columbia Mailman School and is now a medical student at the David Geffen School of Medicine, UCLA. Additional authors include Daniel J. Feaster and Raymond R. Balise, University of Miami Miller School of Medicine; Edward V. Nunes, Columbia University Irving Medical Center; Louisa Gilbert and Nabila El-Bassel, Columbia University School of Social Work.

    This research was supported by the National Institutes of Health through the NIH HEAL Initiative (UM1DA049412).  Access to IQVIA data was provided as part of the IQVIA Institute’s Human Data Science Research Collaborative in support of research activities related to important health system issues arising in the era of COVID-19.

    Columbia University, Mailman School of Public Health

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  • Outpatient Visits Are Critical to Success of Treating Opioid-Use Disorder, Researchers Find

    Outpatient Visits Are Critical to Success of Treating Opioid-Use Disorder, Researchers Find

    Newswise — People with opioid-use disorder who enter treatment are at risk for relapse, overdose or death if they engage in less than two outpatient visits in their first month of care, according to a study coauthored by Rutgers researchers.

    The study, published in The American Journal of Psychiatry, examined the likelihood of patients continuing treatment for opioid-use disorder during their first month in care based on how often they engaged in outpatient visits or other professional services.

    “Engagement in outpatient visits or professional services appears to be a necessary condition for adequate care retention,” said study coauthor Stephen Crystal, the director of the Center for Health Services Research at the Rutgers Institute for Health, Health Care Policy and Aging Research and Distinguished Research Professor at the Rutgers School of Social Work. “Monitoring this engagement may help identify and address barriers and disparities in outcomes.”

    Starting an individual on medication for opioid-use disorder and then retaining them in professional care are two evidence-based interventions for reducing overdoses, according to the National Academies of Sciences, Engineering and Medicine. Researchers said patients participating in outpatient visits during treatment can be a measure of success for care retention, but there is a need to assess how this measure applies specifically to individuals with opioid-use disorder who are receiving medication, such as buprenorphine, as part of treatment.

    Using data reported between 2011 and 2019 from a multisite buprenorphine clinic throughout eight states, researchers examined the relationship between participating in outpatient visits and care retention in nearly 20,000 individuals. The patients were predominately male and non-Hispanic, which is broadly representative of people nationwide who are using buprenorphine for opioid use disorder treatment, according to prior research from study authors.

    Researchers found that nearly half of patients who participated in multiple outpatient visits in their first month of care remained in treatment for a minimum of six months, whereas 2.9 percent of patients who didn’t participate in multiple visits remained in treatment after six months.

    “This finding is critically meaningful and could guide intervention development to prioritize stabilization of high-risk patients early in treatment,” said Arthur Robin Williams, lead author of the study and an assistant professor at Columbia University Department of Psychiatry. “Without early engagement, the great majority of patients will be lost to relapse and possible death.”

    The study’s findings align with the priorities of organizations such as the Substance Abuse and Mental Health Services Administration, which support care coordination and peer navigation services early in treatment to help stabilize patients who otherwise might be lost to follow up. 

    “Many of these services are not currently reimbursable by payers, so insurance plans need to create bundled rates to be more innovative,” Williams said.

    More research is needed to identify patients at the greatest risk for overdose, said the researchers, adding that further research can demonstrate the importance of milestones in opioid-use treatment to develop care-performance measures.

     

    ABOUT RUTGERS INSTITUTE FOR HEALTH, HEALTH CARE POLICY AND AGING RESEARCH 

    Rutgers Institute for Health, Health Care Policy and Aging Research advances health and well-being through meaningful, rigorous and impactful research in the critical areas of behavioral health, health services, health disparities, health policy, health economics, pharmacoepidemiology, and aging research. 

    Since its 1985 founding, the Institute has become nationally renowned for interdisciplinary and translational research. The Institute’s 57,000 square foot facilities are home to six members elected to the National Academy of Medicine and 200 members representing over 30 schools, institutes, and units with adjunct members from 29 national and international universities.

    Institute for Health, Health Care Policy and Aging Research at Rutgers University

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  • Opioid prescribing after surgery remains the same for seniors, but doses are lower, study shows

    Opioid prescribing after surgery remains the same for seniors, but doses are lower, study shows

    Newswise — NEW ORLEANS — Although there has been no decrease in the number of opioid prescriptions seniors receive after surgery, the doses of those prescriptions are lower, according to a study of more than a quarter million Canadian patients being presented at the ANESTHESIOLOGY® 2022 annual meeting.

    “While it’s good news that the doses in opioid prescriptions are being reduced, the fact that the actual number of opioid prescriptions filled has remained the same shows there is still an opportunity for improvement,” said Naheed Jivraj, MBBS, MS, FRCPC, lead author of the study and a critical care medicine fellow at the University of Toronto, Ontario. “That’s particularly true for procedures associated with low postoperative pain that can be effectively controlled with non-opioid medications such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).”

    While opioids can be an important part of pain management after surgery, limiting their use, including by lowering the dose, is important since they can cause major side effects and lead to addiction, as well as a potentially deadly overdose.

    To assess trends in filling pain prescriptions in the week after surgery, the researchers studied the records of 278,366 patients representing all adults in Ontario older than 65 who had one of 14 surgical procedures between 2013 and 2019. The surgical procedures in the study included: thyroid removal, appendix removal, hernia repair, laparoscopic or open removal of the gallbladder, removal of the prostate, open-heart surgery, laparoscopic or open colon removal, laparoscopic vaginal or abdominal hysterectomy, removal of the breast, hip replacement and knee replacement. 

    They identified an increase in patients filling non-opioid prescriptions (e.g., acetaminophen or NSAID) from 9% in 2013 to 28% in 2019. They found most patients also continued to receive a prescription that contained an opioid — 76% in 2013 and 75% in 2019. However, the dose of the opioid prescriptions decreased, from an average of 317 MME (morphine milligram equivalent) in 2013 to an average of 260 MME in 2019. 

    Most patients undergoing procedures such as removal of the appendix or thyroid can get pain relief from acetaminophen or an NSAID; however, few patients who had these procedures filled prescriptions for those non-opioid alternatives, researchers noted.

    “Our study highlights how pain management practices are changing after surgery,” said Dr. Jivraj. “The increase in seniors filling non-opioid prescriptions and the lower opioid dose may reflect the development of surgery-specific prescribing guidelines and the increasing use of anesthesiologist-championed Enhanced Recovery After Surgery protocols and other programs that focus on improving patient outcomes.”

     

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. 

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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    American Society of Anesthesiologists (ASA)

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  • Opioid abuse decreases during pandemic, yet higher rates persist for sexual minorities

    Opioid abuse decreases during pandemic, yet higher rates persist for sexual minorities

    Newswise — NEW ORLEANS — Although opioid abuse in the U.S. is trending downward overall, it remains higher among non-heterosexuals than heterosexuals, according to an analysis of national survey data being presented at the ANESTHESIOLOGY® 2022 annual meeting.

    “This is the first analysis to look at the status of opioid abuse during COVID-19 in this population,” said Mario Moric, M.S., lead author of the research and a biostatistician at Rush University Medical Center, Chicago. “We thought the pandemic would prompt a spike in opioid abuse, but we are happy that this was not the case. However, the higher level of abuse among sexual minorities compared to heterosexuals is a concern. It underscores the need to focus on the risk factors and formulate strategies to reduce opioid abuse in this vulnerable population.”

    The researchers analyzed data collected through the annual National Survey on Drug Use and Health, which provides estimates of the prevalence of alcohol and drug use in the United States. More than 89,000 survey participants self-reported their sexual identity as heterosexual, homosexual or bisexual. The authors determined opioid abuse decreased between 2019 and 2020 among all three groups: from 3.5% to 3.2% for heterosexuals; 7.4% to 4.6% for homosexuals; and 10.3% to 7.6% for bisexuals. Overall, opioid abuse among adults 18 and older, regardless of sexual identity, declined by nearly 1 million, from 8 million adults in 2019 to 7.1 million adults in 2020.

    While opioid abuse went down, drug overdose deaths rose to an all-time high during the pandemic, according to the Centers for Disease Control and Prevention. 

    “We need to conduct more research to understand exactly why overdose deaths spiked during the pandemic,” Moric said. “It’s important to understand that our analysis measured the incidence of opioid abuse, and not the amount of consumption. It could be that while casual abuse declined, patients who tend to abuse opioids in higher amounts and more frequently used them at an even higher rate during the stress of the pandemic, increasing the rate of overdose deaths.”

    This analysis opens the door for future research to focus on identifying possible risk factors for these groups that will lead the development of programs aimed at reducing opioid abuse, the researchers noted. It also provides care teams with important insights that can impact their approach to treating vulnerable patient populations.

    “Clinicians need to be aware of the higher likelihood of recreational use of opioids among sexual minorities compared to non-LGBTQ populations,” Moric added. “With greater awareness of these disparities, we can foster a more compassionate understanding of these patients and provide the most appropriate care and education to address the issue and reduce the stigma.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. 

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

    # # #

    American Society of Anesthesiologists (ASA)

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