Tag: study

"No Evidence" That Medical Marijuana Works For Chronic Pain, Study Finds

The study also found “no evidence” that marijuana use reduced prescription opioid use.

For those experiencing non-cancer chronic pain, medical marijuana may not be as effective as initially thought, according to a new study.

According to Medical Xpress, researchers at UNSW Sydney, who led one of the longest community studies of its kind, discovered no obvious role when it comes to cannabis for the treatment of non-cancer chronic pain.

The Pain and Opioids In Treatment (POINT) study, which took place over four years, discovered that participants who used marijuana for chronic pain reported they were “experiencing greater pain and anxiety, were coping less well with their pain, and reported that pain was interfering more in their life,” when compared to those not using medical marijuana.

“At four-year follow-up, compared with people with no cannabis use, we found that participants who used cannabis had a greater pain severity score, for less frequent cannabis use, greater pain interference score, lower pain self-efficacy scores and greater generalized anxiety disorder severity scores,” authors wrote. “We found no evidence of a temporal relationship between cannabis use and pain severity or pain interference, and no evidence that cannabis use reduced prescribed opioid use or increased rates of opioid discontinuation.”

Researchers did not find any clear evidence that medical marijuana reduced severity of pain or had participants decrease opioid use or dosage. When it comes to medical marijuana, chronic non-cancer pain is the most common reason for use.

The length of this study sets it apart from others, Medical Xpress points out. The POINT study recruited participants through community pharmacies, then completed an overall assessment of their level of pain, physical and mental health, and medication and marijuana use each year.

Of the 1,514 participants, about 80% completed all the assessments, Medical Xpress states. The median number of years of chronic pain was about 10 and the number of years having taken opioids for the pain was about four. Rates of physical and mental health issues among participants were high, Medical Xpress says.

The results of the study were published in Lancet Public Health and imply there may not be as many benefits to medical marijuana as previously thought.

“Chronic non-cancer pain is a complex problem,” said lead author Dr. Gabrielle Campbell. “For most people, there is unlikely to be a single effective treatment… In our study of people living with chronic non-cancer pain who were prescribed pharmaceutical opioids, despite reporting perceived benefits from cannabis use, we found no strong evidence that cannabis use reduced participants’ pain or opioid use over time.”

This study was funded by the National Health and Medical Research Council and led by the National Drug and Alcohol Research Centre at UNSW Sydney.

View the original article at thefix.com

6 July 2018
Link Between Heroin Addiction And Narcolepsy Examined

Could opiates be the key to treating the chronic sleep disorder?

Heroin could be the next big breakthrough in treating narcolepsy.

That’s one possibility raised in a paper published recently in the journal Science Translational Medicine, detailing new work probing the connection between addiction and the chronic sleep disorder.a

When narcoleptics nod off or lose muscle control, it’s caused by a lack of hypocretin in the brain. But to probe the connection further between the wakefulness-controlling chemical and the sleep disorder linked to it, researchers started studying the brains of dead narcoleptics. In the process, they stumbled across one brain that stood out.

It had a lot more hypocretin-producing cells than the other brains – and then the researchers learned that person had been addicted to heroin. So the scientists decided to start looking at the brains of people who had struggled with opioid use disorder before their deaths.

In the first four samples they studied, researchers found the opioid-addicted brains had an average of 54% more hypocretin-producing cells than regular brains.

“So it was natural to ask if opiates would reverse narcolepsy,” study co-author Jerry Siegel, a neuroscientist at the University of California Los Angeles, told Gizmodo.

The next step, Siegel explained, was trying a study with mice.

Over a two-week period, researchers drugged up narcoleptic mice with regular doses of morphine. The experiment upped their hypocretin-making cells, and the effect lasted for a few weeks after scientists cut off the dosage.

Basically, the researchers said, the opiates wake up dormant cells that make the necessary chemical.

“Understanding why opiates ‘awaken’ these cells is a task for the future,” Siegel said.

But other scientists voiced reservations about the work. Even if opioids turn out to be an effective treatment in humans, there are practical limitations.

“No mother of a 15-year-old with narcolepsy would sign onto us giving them several doses of morphine a day,” sleep expert Thomas Scammell of Harvard Medical School told Gizmodo.

Yet, the findings could herald new hope for addiction treatment. If opiates users have more neurons that make hypocretin, the researchers suggested, then maybe they need less.

“If chronic use of opioids is increasing hypocretin production—and the authors show that nicely—then that could amplify the rewarding aspects of these drugs, making addiction all that much worse,” Scammell said. “I think that’s actually the most interesting part of their research.”

View the original article at thefix.com

2 July 2018
Why Some People May Be More Prone To Alcoholism Than Others

A landmark study may have pinpointed a gene that is linked to alcoholism.

New research may provide further clues into how genetics play a role in the development of dependency on drugs and alcohol.

A new study used rats that had been fed a steady diet of alcohol as test subjects; when offered more alcohol or a saccharine solution, a small but significant number continued to choose alcohol over the more preferable sweet offering, even when the choice meant that they would receive an electric shock.

Upon examining the rats’ brains, the researchers found that the rats that chose alcohol had lower levels of a certain gene that controlled the release of a chemical linked to alcohol dependence.

The study’s findings suggest that the gene may be the first step toward a greater understanding of, and even treatment for, alcohol dependency.

The study published in the June 22, 2018 edition of Science, was conducted by a multinational group of researchers from the University of Illinois, Chicago, University of Texas, Austin and Sahlgrenska Academy at the University of Gothenburg, Sweden.

A test group of 32 rats was trained to consume a 20% alcohol solution for 10 weeks until it became a habit for the animals; they were then presented a daily choice of more alcohol or a solution of the artificial sweetener saccharine.

What they found was that the majority of the rats preferred the sugar option over alcohol—a common trait among mammals, as Scientific American noted, because sugar can be easily converted into calories and provide energy for survival. But four rats (12.5% of the study group) chose the alcohol every time, even under the threat of receiving an electric shock if they made that choice.

Additional testing confirmed the scientists’ suspicions. “600 animals later, we found that a very stable population chose alcohol,” said senior study author Markus Heilig, director of the Center for Social and Affective Neuroscience at Linkoping in Sweden.

From there, the scientists examined the brains of the rodent subjects, and found that a gene called GAT-3 was expressed to a much lesser degree in the brains of the rats that chose alcohol.

As Scientific American noted, GAT-3 is linked to a protein that controls the levels of GABA, a major inhibitory neurotransmitter in the brain and one linked with dependency on alcohol.

Further research found that brain samples from deceased humans who had exhibited alcohol dependency also showed lower levels of GAT-3 in the amygdala, which is widely considered to be the brain’s center for emotions and in particular, fear.

Heilig told Scientific American that it makes sense that the lowered levels would be found there and not in the brain’s reward center.

“The rewarding effect of drugs happens in everybody,” he said. “It’s a completely different story in the minority of people who continue to take drugs [and use alcohol] despite adverse consequences.”

Heilig and his team have begun work on a treatment for addiction based on their research; according to Scientific American, the drug suppresses the release of GABA, which could reduce the compulsion to consume alcohol in the face of dangerous circumstances. They are currently working with a pharmaceutical company in hopes of launching tests of their compound on humans.

View the original article at thefix.com

28 June 2018
Can Combining Opioids And Benzos Increase Overdose Risk?

The National Institute on Drug Abuse reports that more than 30% of all overdose deaths that involve opioids also involve benzodiazepines.

When used in combination with opioids, benzodiazepines such as Xanax and Valium can make an individual five times more likely to overdose, a new study published in JAMA Network Open has determined.

The study found that benzodiazepines, which are often prescribed for anxiety, can increase the likelihood of overdose when used with opioids, especially in the first 90 days they are used together.

The National Institute on Drug Abuse (NIDA) reports that more than 30% of all overdose deaths that involve opioids also involve benzodiazepines.

The new study looked at data from over 71,000 people on Medicare Part D. Researchers divided patients into two groups: those who had taken only opioids prior to overdosing and those who had both opioids and benzodiazepines. Researchers “subdivided [the second group] by the cumulative number of days the patients had taken an opioid with a benzo,” Forbes states.

The results showed that for individuals taking both forms of medication, overdose risk was five times higher during the first three months when compared to those using only an opioid.

For the 90 days after the first three months, the risk of overdose doubled. After six months, the risk decreased to the same likelihood as taking only opioids.

“Patients who must be prescribed both an opioid and a benzodiazepine should be closely monitored by health care professionals due to an increased risk for overdose, particularly in the early days of this medication regimen,” lead study author Inmaculada Hernandez, assistant professor at the University of Pittsburgh School of Pharmacy, said in a press release.

A 2017 study published in the BMJ found that from 2001 to 2013, simultaneous opioid and benzodiazepine prescriptions in 315,000 privately insured patients increased by 80%.

As such, one of the factors that researchers considered was the number of clinicians involved with a patient. They found that the more clinicians there were prescribing drugs to a single patient, the greater the risk of overdose.

“These findings demonstrate that fragmented care plays a role in the inappropriate use of opioids, and having multiple prescribers who are not in communication increases the risk for overdose,” said senior study author Yuting Zhang, PhD, of the University of Pittsburgh Graduate School of Public Health, according to Forbes.

This study is not the only one of its kind, as the relationship between opioids and benzodiazepines and the associated risks has been studied previously.

Additionally, earlier in 2018, the FDA published a warning about the potential for respiratory depression issues when taking both medications together, since both depress the central nervous system.

View the original article at thefix.com

28 June 2018
Buprenorphine Exposure Affects Kids At Alarming Rates

The number of children exposed to the addiction drug rose 215% over three years.

As the opioid crisis continues to grow, some children are being put at risk as they are exposed to buprenorphine, an opioid medication used to treat opioid use disorder.

A new study published in the journal Pediatrics found that from 2007 to 2016, more than 11,200 calls were made to poison control centers in the U.S. with concerns about children being exposed to buprenorphine. Of those, 86% were about children under age 6 and 89% were unintentional exposures.

“This is never prescribed for children under 6. It is a significant risk to them,” Henry Spiller, director of the Central Ohio Poison Center and an author of the study, told CNN. “We’re not quite sure why it stands out so much. Perhaps the parents who have this may not think it’s as risky as their other opiates because it doesn’t have the big effect that the other opiates do for them.”

Of the 11,275 children exposed to the medication, the overall exposure rate per 1 million grew by more than 215% from 2007 to 2010. It then decreased 42.6% from 2010 to 2013, before increasing again in 2016 by 8.6%.

Dr. Jason Kane, an associate professor of pediatrics and critical care at University of Chicago Medicine Comer Children’s Hospital, tells CNN that the increase in exposure has to do with the increase in adults using buprenorphine as a treatment option.

“This is not the first study to show these data, but it is the latest study to show a medication whose design it is to help adults with narcotic or opioid addiction is ending up poisoning, mostly unintentionally, children and in particular those who are most vulnerable,” Kane said.

Buprenorphine is an opioid receptor stimulant as well as a blocker. It is considered an opioid but does not have the same effect as other opioids for adults, thought it can still be habit-forming. For children, however, it can have a stronger effect on the respiratory system.

“In adults, the respiratory depression, the part that slows the breathing and you stop breathing, is limited, and so there’s a lot less respiratory depression in adults,” Spiller told CNN. “That’s why it was felt to be safer. Unfortunately, in very young children under 5, preschoolers, toddlers, infants… that protection isn’t there, and they do get this respiratory depression. It does affect their breathing.”

Of adolescent exposures, 77% were intentional and more than one-quarter used the medication with another substance.

“It was surprising that adolescents were actually using it for abuse. It’s very specific,” Spiller told CNN. “You have to be in a program to get this. It’s carefully managed. It’s not widely available… It is available on the street, but essentially, the majority of this is from these management programs and someone’s in therapy, someone in the house, them or a family member.”

According to CNN, study authors expect the number of exposures to continue to increase.

To limit exposure, Kane recommends disposing unused medications, using child-proof caps and making sure medications are labeled correctly.

“Seven children under the age of 6 died as a result of an accidental poisoning from this drug, which was present in someone’s home, prescribed with the goal of making someone else better,” Kane said to CNN, adding, “that’s a striking thing for me.”

View the original article at thefix.com

26 June 2018
Link Between Trump Support And Opioid Use Revealed In New Study

“When we look at the two maps, there was a clear overlap between counties that had high opioid use … and the vote for Donald Trump,” said the study’s author.

There may be a geographic connection between those who supported Trump in the 2016 election and prescriptions for opioids, according to a new study published in the medical journal JAMA Network Open.

James S. Goodwin, chair of geriatrics at the University of Texas Medical Branch and the study’s lead author, along with other researchers, examined data from numerous sources which included the Census Bureau and the 2016 election, as well as data from Medicare Part D, a program for prescription drugs that helps those with disabilities and the elderly.

“When we look at the two maps, there was a clear overlap between counties that had high opioid use… and the vote for Donald Trump,” Goodwin told NPR. “There were blogs from various people saying there was this overlap. But we had national data.”

In order to estimate the amount of opioid use by county, Goodwin and his team utilized the number of Medicare Part D enrollees who had three months or more worth of opioid prescriptions. According to Goodwin, it was harder to estimate the amount of illegal opioid use, though prescription opioid use is strongly correlated with it.

“There are very inexact ways of measuring illegal opioid use,” Goodwin told NPR. “All we can really measure with precision is legal opioid use.”

In the research process, the team looked at a number of factors to determine how a county’s rate of chronic opioid prescriptions was influenced. They found that in the 2016 election, Trump support was closely tied to opioid prescriptions. In counties with higher-than-average numbers of chronic opioid prescriptions, 60% of those who voted did so for Trump whereas in counties with lower-than-average prescriptions, only 39% voted for him.

NPR also states that some of the correlation could have to do with social and economic factors, as many rural counties with struggling economies voted for Trump, and those are the areas where opioid use is common.

“As a result, opioid use and support for Trump might not be directly related, but rather two symptoms of the same problem—a lack of economic opportunity,” NPR noted.

Goodwin and his team also analyzed factors such as unemployment rate, median income, how rural areas were, education level and religious service attendance. They found that these factors account for about 66% of the connection between Trump voters and opioid use, but not the remaining percentage.

“It very well may be that if you’re in a county that is dissolving because of opioids, you’re looking around and you’re seeing ruin. That can lead to a sense of despair,” Goodwin told NPR. “You want something different. You want radical change.”

For some areas hit hard by the opioid crisis, NPR states, the Trump presidency may have seemed like a solution.

While the study shows a likely link, it isn’t definitive and has shortcomings, Goodwin states.

“We were not implying causality, that the Trump vote caused opioids or that opioids caused the Trump vote,” he cautions. “We’re talking about associations.”

View the original article at thefix.com

25 June 2018
Are Health Insurers Driving The Opioid Crisis?

While the brunt of the negative attention has focused on drug suppliers and prescribers, experts are now examining the role that insurers have played in the epidemic.

Health insurers could be stoking the opioid epidemic, according to a new study published Friday in the journal JAMA Network Open.

“Our findings suggest that both public and private insurers, at least unwittingly, have contributed importantly to the epidemic,” said study senior author Dr. G. Caleb Alexander, an associate professor in the Bloomberg School’s Department of Epidemiology.

That’s based on a 2017 analysis of 15 Medicaid plans, 15 Medicare plans and 20 private insurers, which revealed that many aren’t applying evidence-based “utilization management” rules that could cut down on opioid overuse.

“Opioids are just one tool in the pain management tool box, and unfortunately, many of the plans that we examined didn’t have well-developed policies in place to limit their overuse,” Alexander said.

The study comes even as a long-term uptick in opioid-related deaths has pushed dozens of states, counties, and cities to launch lawsuits against drug companies and distributors that make and provide the addictive prescription painkillers fueling the overdose crisis.

For the most part, the brunt of the negative attention has focused on drug suppliers and prescribers rather than on insurers, but the new findings by the Johns Hopkins Bloomberg School of Public Health probes what roles insurance plans could play in the epidemic.

The researchers identified specific utilization management tools that insurers may not be relying on enough, such as restricting the quantity of drugs doctors can prescribe, requiring prior authorization or mandating that providers begin with less risky drug alternatives.

Quantity limits are commonly used for opioids—but those limits might still be higher than they should be, the researchers found. Generally, insurers capped scripts at a 30-day supply instead of the shorter limit recommended by the CDC.

Across all the plans studied in Medicare, Medicaid and commercial insurers, doctors typically weren’t required to start with less addictive alternatives like over-the-counter NSAIDs before doling out more powerful opioids.

A median of just 9% of the covered opioids in Medicaid plans required doctors to start with something less risky first, the researchers found. For commercial plans, the median number was around 4%. Medicare plans typically had almost no so-called “step therapy” requirement.

The majority of opioid prescriptions didn’t require prior authorization, which is when the prescriber has to call the insurer for approval before writing the prescription. Some insurers, however, have begun putting such policies in place for patients with chronic, non-cancer pain.

“Insurers can either be part of the problem, or part of the solution,” Alexander said. “The good news is that an increasing number of health plans are recognizing their contribution to the epidemic and developing new policies to address it. The bad news is that we have a very long way to go.”

The analysis comes on the heels of a 2017 deep-dive by the New York Times and ProPublica, which found that many insurers limited access to less addictive —but more expensive—alternatives.

“This is not a hypothetical problem,” Rep. Elijah Cummings (D-Maryland), later wrote in a letter to insurance companies. “In my home state of Maryland, 550 people died of an overdose in the first three months of 2017 alone. Synthetic opioids like fentanyl are driving up the epidemic’s death toll, but prescription opioids contribute significantly to this crisis by fostering addiction and causing fatal overdoses.”

View the original article at thefix.com

25 June 2018
Serious Bacterial Infection Linked To Injection Drug Use

According to a new study, the number of MRSA cases in those who use injection drugs more than doubled from 2011 to 2016.

Those who use inject illicit drugs may be at risk of more than an overdose, as new government data claims that such individuals are more susceptible to a potentially fatal infection.

Individuals who use heroin or other injection drugs are 16 times more susceptible to develop infections or illnesses from MRSA, a dangerous bacteria.

MRSA, or methicillin-resistant Staphylococcus aureus, is an infection caused by a type of staph bacteria, the Mayo Clinic reports. However, unlike other forms of staph, it does not respond well to antibiotics, making it more dangerous.

“Drug use has crept up and now accounts for a substantial proportion of these very serious infections,” said Dr. William Schaffner of Vanderbilt University, according to CBS News.

While other studies have shown that HIV and hepatitis C have spread among injection drug users, this is the first study to focus on this type of bacteria, referred to as a “superbug,” according to CBS.

Although MRSA can be found on people’s skin, it does not tend to become dangerous until it enters the bloodstream, CBS notes. Health officials estimate that about 11,000 deaths per year in the U.S. are due to MRSA and that while the rate of infection in hospitals and nursing homes has decreased, the rate in those using illicit drugs continues to rise.

Dr. Isaac See of the Centers for Disease Control and Prevention (CDC), also a study author, states that MRSA “is on the skin, and as the needle goes into the skin it brings the bacteria with it,” according to CBS.

According to the study’s findings, the number of MRSA cases that involved those who use injection drugs more than doubled from 2011 to 2016, from 4% to 9%.

According to the news outlet, this study took into account MRSA infections at hospitals in Connecticut and in parts of California, Georgia, Minnesota, New York and Tennessee. Of the approximately 39,000 cases, about 2,100 were from individuals who had used injection drugs.

Study authors note that if the amount of people using injection drugs continues to rise as will the number of MRSA cases, this could be detrimental to efforts being made to curb the crisis.

“Increases in nonsterile injection drug use are likely to result in increases in the occurrence of invasive MRSA infections among persons who inject drugs, underscoring the importance of public health measures to curb the opioid epidemic,” study authors wrote.

View the original article at thefix.com

18 June 2018
Potential Treatment To Prevent Relapse Shows Promise

Researchers only tested the treatment mechanism out on morphine though they are interested in seeing if it works on other drugs.

The journal Addiction Biology published research from scientists at the University of Bath which offers a new mechanism for preventing drug-addiction relapses.

According to Medical Xpress, the Bath scientists collaborated with colleagues from RenaSci and University of Surrey to use an animal model in order to study specific behaviors of rats and mice that sought out morphine after being exposed to environmental cues associated with the drug.

The scientists then withheld morphine from the rats and mice and then reintroduced the environmental cues. The rodents then lapsed into drug-seeking behaviors. The premise set, the scientists then tested the effect of a brain neurotransmitter blocker called acetylcholine.

Acetylcholine is crucial to the memory process. Using the blocker on a specific acetylcholine receptor on the rats and mice, the researchers observed that the blocker drug, called methyllycaconitine, or MLA, did not block the rodents from searching for morphine, but did prevent them from ingesting it.

Moving forward with that information, the researchers honed in on a part of the brain vital for memory, the ventral hippocampus. The venal hippocampus is linked with emotional memory, crucial in the functions of addiction and relapse.

Relapse is a pervasive reality for those with an addiction to drugs or alcohol. While studies present differing statistics on relapse rates, Science Daily reports that “the majority of addicts return to drug-taking within 12 months of quitting.”

Triggers for relapse are numerous and range from physical cues such as drug paraphernalia to emotional cues such as a painful setback. The study shows that MLA—at least in animal models—works to prevent relapsing even when exposed to those environmental cues.

Medical Xpress quotes Professor Sue Wonnacott, from the University of Bath’s Department of Biology & Biochemistry, as saying, “More work needs to be done to uncover the brain mechanisms involved, but it raises the prospect of erasing long-term drug-associated memories that underpin addiction and the propensity to relapse.”

Dr. Chris Bailey from the University of Bath’s Department of Pharmacy & Pharmacology looked forward to more research which could reveal if MLA blocks relapse for other drug addictions besides morphine.

He said, “We already have evidence, in the same animal model, that it is effective against the more potent opioid, heroin. If MLA has similar effects against other drugs of abuse such as cocaine it would be even more encouraging.”

Research is being done on relapse prevention using other methods for other drugs, as well.

This year, a promising study published in Neuropsychopharmapsychology (also done on animals), found that they were able to reduce relapse rates with a drug used to treat diabetes and obesity, called extendin-4. No adverse reactions were found, and research continues to move forward.

View the original article at thefix.com

15 June 2018
Opioid Deaths Have Surpassed Vietnam War Fatalities, Study Says

A new study examined the 15-year period from January 2001 to December 2016 to determine the number of American deaths caused by the opioid crisis.

American deaths as a result of the opioid crisis have surpassed those during the Vietnam War, a new study has found.

According to the Washington Post, less than 1% of American deaths in the year 1968 were due to serving in the Vietnam war. Now, a new study has found that in 2016, 1.5% of deaths were at the hands of opioids.

The study, which was published in the Journal of the American Medical Association, looked at the 15-year period from January 2001 to December 2016 to determine the number of American deaths caused by the opioid crisis.

It found that between 2001 and 2016, the number of deaths caused by the opioid crisis rose from 9,489 to 42 ,245—a 345% increase.

According to the study, in 2001, opioids were responsible for 0.4% of deaths, or 1 in 255 people. But 15 years later, in 2016, that rose to 1.5%, or 1 in 65 deaths—a 292% increase. Study authors found that the greatest impact was on those ages 24 to 35, an age group in which 20% of deaths were associated with opioids. Study authors also found that deaths connected to opioids were more prominent in men than women.

In all, study authors estimate that in 2016 alone, nearly 1.7 million years of life were lost in the U.S. population due to the opioid crisis.

“These findings highlight changes in the burden of opioid-related deaths over time and across demographic groups in the United States,” study authors wrote. “They demonstrate the important role of opioid overdose in deaths of adolescents and young adults as well as the disproportionate burden of overdose among men.”

Study findings also indicated that there has been an increase in the number of opioid-related deaths in those 55 and older.

“The relative increase in recent years requires attention, as it could be indicative of an aging population with increasing prevalence of opioid use disorder,” study authors noted. “This is particularly problematic as recent estimates from the United States suggest that the prevalence of opioid misuse among adults aged 50 years and older is expected to double (from 1.2% to 2.4%) between 2004 and 2020.”

Because of the impact on those of younger ages, study authors also indicated that there is a need to put more programs and policies in place.

“Premature death from opioid-related causes imposes an enormous public health burden across the United States,” study authors wrote. “The recent increase in deaths attributable to opioids among those aged 15 to 34 years highlights a need for targeted programs and policies that focus on improved addiction care and harm reduction measures in this high-risk population.”

According to the Post, this research leaned on Centers for Disease Control and Prevention (CDC) data, which is thought to underestimate the number of opioid deaths by 20 to 30%, resulting in a “conservative estimate” of the true impact of the crisis.

View the original article at thefix.com

14 June 2018