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Separating Side Effects Could Hold Key for Safer Opioids

Separating Side Effects Could Hold Key for Safer Opioids

NIH-funded scientists may have revealed brain functions in pre-clinical research that widen the safety margin for opioid pain relief without overdose

Opioid pain relievers can be extremely effective in relieving pain, but can carry a high risk of addiction and ultimately overdose when breathing is suppressed and stops. Scientists have discovered a way to separate these two effects -- pain relief and breathing -- opening a window of opportunity to make effective pain medications without the risk of respiratory failure. The research, published today in Cell, was funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

Opioid medications suppress pain by binding to specific receptors (proteins) in the brain; these same receptors also produce respiratory suppression. However, the way these receptors act to regulate pain and breathing may be fundamentally different. Studies using mouse genetic models suggest that avoiding one particular signaling pathway led to more favorable responses to morphine (pain relief without respiration effects). The investigators then explored if they could make drugs that would turn on the pathways associated with pain relief and avoid the pathways associated with respiratory suppression.

"We are pleased to have uncovered a potential new mechanism to create safer alternatives to opioid medications, ones that would be far less likely to cause the side effects that lead to overdose deaths associated with the misuse of opioids," said NIDA Director Nora D. Volkow, M.D. "We are excited that basic research on how opioid drugs work in the brain has led to this novel approach, and that we continue to make critical progress in this area."

How the pathways split following receptor activation is referred to as biased signaling. The study showed that as the degree of bias (divergence) increased, so too did the ability of an opioid to reduce pain in mice without affecting breathing. Similarly, compounds that favor the breathing pathway produced more respiratory side effects at lower doses. Ultimately, opioids with a larger divergence (bias factor) had a larger margin of safety, or therapeutic window, opening up an opportunity for medication intervention.

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Some Experts Question Opioid Commission’s Marijuana Warning

Some Experts Question Opioid Commission’s Marijuana Warning

The chair of President Trump’s Opioid Commission warned about the dangers of marijuana, in a letter accompanying the release of the commission’s final report.

Some experts are questioning the commission’s view that marijuana could further fuel the opioid crisis.

New Jersey Governor Chris Christie, the chair of the commission, warned against legalizing marijuana in the midst of the opioid epidemic.

One researcher, Dr. Chinazo Cunningham, a professor of medicine at the Albert Einstein College of Medicine, told CNN she is surprised to see negative language about marijuana in the opioid report. “Research that examines pain and marijuana shows that marijuana use significantly reduces pain,” she said. “In addition, the majority of studies examining marijuana and opioids show that marijuana use is associated with less opioid use and less opioid-related deaths.”

Dr. Cunningham is conducting the first long-term study to test whether medical marijuana reduces opioid use among adults with chronic pain, including those with HIV.

Original linkOriginal author: Ezra
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Long-Acting and Daily Medications to Treat Opioid Addiction Found Equally Effective

Long-Acting and Daily Medications to Treat Opioid Addiction Found Equally Effective

A new study finds a long-acting medication and a short-term drug that must be taken daily are equally effective in treating opioid addiction.

Researchers at NYU Langone Health found extended-release naltrexone (Vivitrol) was as safe and effective as more commonly prescribed buprenorphine-naloxone (Suboxone) in curtailing opioid use, relapse, treatment drop-out, and overdose.

The study, which was sponsored by the National Institute on Drug Abuse, was published in The Lancet.

The study is the first major head-to-head comparison of the treatments, according to The Washington Post. Researchers found each treatment had disadvantages. Short-acting medicines must be taken daily for years or even a lifetime. Naltrexone, which is given as a monthly injection, cannot be started until a person is fully detoxified from opioids—which more than 25 percent of the study subjects failed to do.

More than half of the study subjects relapsed at least once, regardless of which treatment they received.

Original linkOriginal author: Ezra
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DEA Rule Allows Criminal Prosecution for Fentanyl Trafficking

DEA Rule Allows Criminal Prosecution for Fentanyl Trafficking

The Drug Enforcement Administration (DEA) will classify illicit versions of fentanyl at the same level as heroin, Reuters reports.

The action will make it easier for federal prosecutors and agents to prosecute traffickers of all forms of fentanyl-related substances, the agency said.

Legally prescribed fentanyl is classified as a Schedule II drug, which means it is highly addictive but has a medical purpose.

The new DEA order classifies illicit fentanyl as a Schedule I drug, along with heroin. Schedule I drugs are considered addictive, with no medicinal purpose.

The DEA order will last up to two years, with a possibility of a one-year extension if certain conditions are met. In a statement, Attorney General Jeff Sessions said, “By scheduling all fentanyls, we empower our law enforcement officers and prosecutors to take swift and necessary action against those spreading these deadly poisons. I also urge the many members of Congress who clearly share our concern and alarm over fentanyl’s role in our opioid overdose epidemic to do their part by permanently scheduling these lethal substances.”

Original linkOriginal author: Ezra
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Teens Dependent on Marijuana and Alcohol Struggle with Success Later in Life

Teens Dependent on Marijuana and Alcohol Struggle with Success Later in Life

Teens who are dependent on marijuana and alcohol struggle to achieve hallmarks of adult success, such as graduating from college, getting married, having a full-time job and earning a good salary, a new study finds.

Researchers at the University of Connecticut tracked 1,165 study participants, starting at age 12.

They checked in on them at two-year intervals, until they were between 25 and 34 years old, HealthDay reports. Most of the participants had a grandparent, parent, aunt or uncle with an alcohol problem. Marijuana and alcohol dependence appeared to have a more severe effect on young men.

“Parents should try to delay their children’s onset of use as much as possible,” said researcher Victor Hesselbrock. “If you can push regular use back well into adolescence, the kids do a lot better.”

The study was presented at the annual meeting of the American Public Health Association.

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Millions of Dollars Needed for Trump’s Anti-Opioid Ad Campaign, Advocates Say

Millions of Dollars Needed for Trump’s Anti-Opioid Ad Campaign, Advocates Say

The anti-drug ad campaign advocated by President Trump’s opioid commission will need millions of dollars in funding, advocates tell The Hill.

It is not clear how such a campaign would be funded, the article notes.

New Jersey Governor Chris Christie, who chaired the commission, said the campaign should be paid for by the federal government, with private sector partners. The report, released recently, included 56 recommendations, including an aggressive multimedia campaign to fight the opioid epidemic.

An ad campaign must be part of a more comprehensive approach that includes strengthening treatment and changing opioid prescribing patterns, advocates say.

In order to be effective, a campaign must be based on evaluations of what has been effective in the past, and must frequently test the ad’s message with the target audience, they note. “We’ve learned a lot about how to communicate about these issues in the past three decades or so. There’s a lot of really good science on this right now,” said Marcia Lee Taylor, Chief Policy Officer of the Partnership for Drug-Free Kids.

Original linkOriginal author: Ezra
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Combo of Acetaminophen and Ibuprofen as Effective as Opioids for Acute Pain

Combo of Acetaminophen and Ibuprofen as Effective as Opioids for Acute Pain

A study of patients who went to the emergency room suffering from acute pain found those given a combination of ibuprofen and acetaminophen reported as much pain relief as those who were given opioids.

The 416 patients in the study had acute pain in their shoulders, arms, hips or legs, the Los Angeles Times reports.

About 20 percent of the patients had a bone fracture, the researchers wrote in the Journal of the American Medical Association. Other patients had injuries such as a sprained ankle or dislocated shoulder.

Patients were assigned to one of four groups. One group received a combination ibuprofen/acetaminophen tablet (containing the medications found in Advil and Tylenol. The other groups received a drug containing a prescription opioid, such as Percocet (a combination of oxycodone and acetaminophen), Vicodin (hydrocodone and acetaminophen) or Tylenol No. 3 (codeine and acetaminophen).

Patients were asked to rate their pain when they arrived at the hospital and two hours after they received their medication. Those who took the acetaminophen/ibuprofen tablet reported pain relief similar to those who received an opioid.

Original linkOriginal author: Ezra
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Drug Overdose Deaths Rose More Than 17 Percent Last Year: CDC

Drug Overdose Deaths Rose More Than 17 Percent Last Year: CDC

 Drug overdose deaths increased more than 17 percent between 2015 and 2016, according to a new report by the Centers for Disease Control and Prevention (CDC).

The overdose death rate rose to almost 20 people per 100,000, up from 16.3 per 100,000 the previous year, The New York Times reports.

Drug overdoses are now the leading cause of death for Americans under age 50, the CDC found.

Recently, these deaths have been driven by overdoses of fentanyl and other synthetic opioids, according to Dr. Robert Anderson, Chief of the CDC mortality statistics branch. “The main message is the drug rate went up a lot again, and of course we’re worried about it,” he said.

Original linkOriginal author: Ezra
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Hospitals Overwhelmed With Treating Diseases Resulting From IV Drug Use

Hospitals Overwhelmed With Treating Diseases Resulting From IV Drug Use

Hospitals are struggling to deal with an overwhelming number of cases of diseases that result from intravenous opioid use, including hepatitis C, endocarditis and the antibiotic-resistant infection MRSA.

Hepatitis C is the most common infectious disease that affects people with opioid use disorder, USA Today reports.

Reported cases of the disease almost tripled between 2010 and 2015.

Endocarditis—a condition in which the heart’s inner lining is inflamed—is a side effect of opioid addiction. Hospitalizations for endocarditis rose almost 50 percent from 2002 to 2012, at an average cost of $50,000 per patient.

MRSA is the second most common co-occurring condition with opioid use disorder, the article notes. The cost of treating the infection is about $60,000 per patient.

Original linkOriginal author: Ezra
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Provide Feedback on the President's Commission Recommendations

commission-on-addiction-image

The Addiction Policy Forum is coordinating a response to the President's Commission Recommendations on Combatting Drug Addiction and the Opioid Crisis. You can read the final report here.

You can help the Addiction Policy Forum by completing their survey by clicking the button below and giving your views.

Take the Survey

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Teens Bring Juul E-Cigarette Device, Which Looks Like USB Flash Drive, to School

Teens Bring Juul E-Cigarette Device, Which Looks Like USB Flash Drive, to School

School officials report a growing number of teens are bringing a new e-cigarette device called a Juul vaporizer to school.

The device looks like a USB flash drive, and charges when plugged into a laptop, USA Today reports.

Juul is small enough to fit inside an enclosed hand. It comes with pods of e-liquid in sweet flavors such as mango, fruit medley and crème brulee. The devices and flavored pods can be ordered online.

U.S. Senator Chuck Schumer of New York wrote a letter to the Food and Drug Administration (FDA), asking it to reverse a recent decision to delay the regulation of e-cigarettes popular among teens, such as Juul.

“To know that New York kids are much more likely to be using these new-age e-cig devices, like Juul, is not only concerning, but it could be dangerous,” Schumer said in a statement. “Up until now, the FDA was on track to reign in e-cigs and regulate them like any other tobacco product, but this recent delay, coupled with the new numbers showing a rise in the use of gadgets like Juul, which can fool teachers and be brought to school, demands the FDA smoke out dangerous e-cigs and their mystery chemicals before more New York kids get hooked.”

Original linkOriginal author: Ezra
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NIAAA Alcohol Treatment Navigator: Pointing the Way to Quality Care

NIAAA Alcohol Treatment Navigator: Pointing the Way to Quality Care

 

Source: Blog by George F. Koob, PhD. NIAAA Director

Welcome to my first-ever NIAAA Director’s Blog. I look forward to using this space to discuss significant advances in alcohol research and to highlight work supported by NIAAA. In this first installment, I would like to introduce you to an exciting and important new online resource developed by NIAAA – the Alcohol Treatment Navigator. In any given year, more than 15 million adults in the US meet the diagnostic criteria for alcohol use disorder (AUD), but less than 10% of them receive treatment. Meanwhile, many of those in treatment may not receive the care that best fits their needs.

What accounts for this alcohol “treatment gap?”

Often, finding quality AUD care can be complicated, and many people aren’t aware of the full range of available treatment options. It can also be difficult to tell if a provider is offering good quality treatment – what we call “evidence based care” – that is, treatment that is grounded in clinical and health services research that demonstrates positive treatment outcomes.

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DEA Collects Record Number Of Unused Pills As Part Of Its 14th Prescription Drug Take Back Day

DEA Collects Record Number Of Unused Pills As Part Of Its 14th Prescription Drug Take Back Day

The public returns record number of potentially dangerous prescription drugs

Americans nationwide did their part to reduce the opioid crisis by bringing the DEA and its more than 4,200 local and tribal law enforcement partners a record-setting 912,305 pounds-456 tons-of potentially dangerous expired, unused, and unwanted prescription drugs for disposal at more than 5,300 collection sites. That is almost six tons more than was collected at last spring's event.This brings the total amount of prescription drugs collected by DEA since the fall of 2010 to 9,015,668 pounds, or 4,508 tons.

Now in its 8th year, National Prescription Drug Take Back Day events continue to remove ever-higher amounts of opioids and other medicines from the nation's homes, where they could be stolen and abused by family members and visitors, including children and teens. The DEA action comes just days after President Donald J. Trump announced the mobilization of his entire Administration to address drug addiction and opioid abuse by directing the declaration of a Nationwide Public Health Emergency to address the opioids crisis.

"More people start down the path of addiction through the misuse of opioid prescription drugs than any other substance. The abuse of these prescription drugs has fueled the nation's opioid epidemic, which has led to the highest rate of overdose deaths this country has ever seen," said Acting Administrator Robert W. Patterson. "This is a crisis that must be addressed from multiple angles. Educating the public and removing these medications from households across the Unites States prevents misuse where it often starts."

This year, DEA worked with its tribal law enforcement partners to set up 115 collection sites on tribal lands. Opioid addiction impacts Native American communities just as it does all parts of American society. By partnering with FBI, BIA, and tribal law enforcement, the DEA was able to greatly expand tribal participation in the Take Back program. DEA remains committed to supporting public safety in American Indian and Alaska Native communities.

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NIDA Launches Two Adolescent Substance Use Screening Tools

NIDA Launches Two Adolescent Substance Use Screening Tools

The National Institute on Drug Abuse (NIDA) has launched two evidenced-based online screening tools that providers can use to assess substance use disorder risk among adolescents 12-17 years old.

These tools can be self-administered or completed by clinicians in less than two minutes. They are being offered through the NIDAMED Web Portal.

The American Academy of Pediatrics recommends universal screening in pediatric primary settings, and these tools help providers quickly and easily introduce brief, evidence-based screenings into their clinical practices. Providers can select the tool that best fits their practice.

The screening options are:

For more information on adolescent substance use screening tools, click here.

Original linkOriginal author: Ezra
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Patients Treated with Naloxone Continue to be at High Risk of Overdose: Study

Patients Treated with Naloxone Continue to be at High Risk of Overdose: Study

A new study finds 10 percent of people saved by the opioid overdose antidote naloxone die within a year of treatment.

“Patients who survive opioid overdoses are by no means ‘out of the woods,'” lead study author Scott Weiner, MD, Director of the Brigham Comprehensive Opioid Response and Education Program at Brigham and Women’s Hospital, said in a news release. “These patients continue to be at high-risk for overdose and should be connected with additional resources such as counseling, treatment and buprenorphine.”

The study, presented at the annual meeting of the American College of Emergency Physicians, found half of patients who died within a year of naloxone treatment died within one month of treatment, HealthDay reports.

Original linkOriginal author: Ezra
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New Rule Allows Health Providers to Share Information about Overdose with Family

New Rule Allows Health Providers to Share Information about Overdose with Family

Under a new federal rule, health providers will be allowed to share information about a drug overdose with family members if the patient is in crisis or incapacitated.

The new rule, announced by the Trump Administration, relaxes a federal privacy rule that has prevented health providers from notifying family members about an overdose, The Wall Street Journal reports.

“We know that support from family members and friends is key to helping people struggling with opioid addiction, but their loved ones can’t help if they aren’t informed of the problem,” Roger Severino, Director of the Office for Civil Rights at the Department of Health and Human Services, said in a statement. “Our clarifying guidance will give medical professionals increased confidence in their ability to cooperate with friends and family members to help save lives.”

The rule was created in the 1970s, when soldiers returning from Vietnam with substance use disorders avoided treatment because they feared they could be arrested for drug use.

Original linkOriginal author: Ezra
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Addressing the Opioid Crisis Means Confronting Socioeconomic Disparities

Addressing the Opioid Crisis Means Confronting Socioeconomic Disparities

Blog by Dr. Nora Volkow, Director, National Institute on Drug Abuse (NIDA)

The brain adapts and responds to the environments and conditions in which a person lives. When we speak of addiction as a chronic disorder of the brain, it thus includes an understanding that some individuals are more susceptible to drug use and addiction than others, not only because of genetic factors but also because of stress and a host of other environmental and social factors in their lives that have made them more vulnerable.

Opioid addiction is often described as an “equal opportunity” problem that can afflict people from all races and walks of life, but while true enough, this obscures the fact that the opioid crisis has particularly affected some of the poorest regions of the country, such as Appalachia, and that people living in poverty are especially at risk for addiction and its consequences like overdose or spread of HIV. The Centers for Disease Control and Prevention (CDC) considers people on Medicaid and other people with low-income to be at high risk for prescription drug overdose.

Some of the reasons have to do with access and quality of health care received by people in economically disadvantaged regions. According to the US Department of Health and Human Services, people on Medicaid are more likely to be prescribed opioids, at higher doses, and for longer durations—increasing their risk for addiction and its associated consequences. They are also less likely to have access to evidence-based addiction treatment. But psychological factors also play a role.

Last year, economists Anne Case and Angus Deaton attributed much of the increased mortality among middle-aged white Americans to direct and indirect health effects of substance use especially among those with less education, who have faced increasing economic challenges and increased psychological stress as a result.

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Drug Use Disorder vs. Drug Misuse - What is the Difference?

Drug Use Disorder vs. Drug Misuse - What is the Difference?

In 2016, approximately 2.1 million Americans over the age of 11 suffered from addiction to opioids such as the prescription pain medications OxyContin and Vicodin or the illegal drug heroin. Yet, 11.8 million people – nearly six times as many – reported misusing opioids, primarily prescription medications.

Although it does not receive the same media attention as addiction – clinically known as opioid use disorder - this startling figure highlights a serious yet often overlooked problem within our society: the issue of opioid misuse.

WHAT IS THE DIFFERENCE BETWEEN “DRUG USE DISORDER” AND “DRUG MISUSE”?As the clinical term for drug addiction, drug use disorder (DUD) describes a complex disease that affects both the brain and the body. DUD, characterized by the compulsive use of one or more drugs, such as opioids, despite serious health and social consequences, typically develops during an individual’s adolescence and may affect him/her for an extended period of time.

DUD changes an individual’s brain, particularly the parts responsible for reward, motivation, learning, judgment and memory. It also damages various body systems, such as the nervous system, cardiovascular system and immune system. Addiction can also have a negative impact on a person’s mental health, personal relationships, work or school performance, and financial stability.

Drug misuse, on the other hand, is not a diagnosed disease like addiction but a problematic pattern of drug use. When talking about prescription opioids, drug misuse includes the use of controlled drugs, as classified by the federal government, either:

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In Ontario, Individuals with Alcoholic Liver Disease Will Not Have to Wait Six Months for Liver Transplants

In Ontario, Individuals with Alcoholic Liver Disease Will Not Have to Wait Six Months for Liver Transplants

Ethical principles stand behind healthcare providers who withhold medical treatments that are “futile or pointless.” But withholding treatment can be controversial. For example, the family of a gravely ill patient might not agree with professionals that an unproven treatment is futile.

Even when scientific evidence in favor of a treatment accumulates, medical practitioners can be slow to embrace it. In Ontario, Canada, Debra Selkirk combined scientific reports with her powerful personal story, seeking to overturn the rule that individuals with advanced alcoholic liver disease must demonstrate six months of abstinence from alcohol to be eligible for a liver transplant.

Debra shares her account of that process below.

Mark Selkirk died on November 24, 2010 from liver failure caused by alcohol use disorder.  He was never assessed for a liver transplant because he had not been alcohol-free for 6 months, a restriction placed on alcoholic liver disease patients (ALD) around the world.

The 6-month wait remains the most controversial policy in liver transplantation. Liver transplant pioneer surgeon Dr. Thomas Starzl began writing about its injustice as early as 1988, saying “…the imposition of an arbitrary period of abstinence before going forward with transplantation would seem medically unsound or even inhumane.”

Subsequent research concluded that the post-transplant rate of return to heavy drinking is extremely low. Organ loss due to drinking is even more rare. In 2008, a comprehensive analysis of international data by a University of Pittsburgh team established the return to heavy drinking at 2.5 percent in any given year. The study concluded, “The average rates of all outcomes we examined suggest that during any given year of observation, most transplant recipients with substance use histories will neither use substances nor become nonadherent to components of the medical regimen.”

Additional studies support similar conclusions, yet most transplant centers continue to deny transplants to ALD patients until they reach the 6-month benchmark. The policy remains intact, based largely on stigma against patients with alcohol use disorder, fueled by a fear that the public will be less likely to donate their organs if they think livers are being wasted by transplanting them into individuals with alcohol use disorder.

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NCADD Affiliate Executive Director Featured in NY Times Op Ed

NCADD Affiliate Executive Director Featured in NY Times Op Ed

Fay Zenoff, Executive Director of NCADD’s San Francisco Affiliate, the Center for Open Recovery, was featured in an Op Ed in the November 5 New York Times.

The piece, entitled, “Let’s Open Up About Addiction,” by Laura Hilgers, talks about the new openness toward recovery, including its risks as well as its benefits.

Ms. Hilgers, who has a child in recovery, acknowledges the safety that anonymity provides but also the value of hearing from those, such as Fay, who are leading successful lives in recovery. Click here to read the article.

Original linkOriginal author: Ezra
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