Alcohol, Opioids, & other Substance Disorders

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Scientists show how blocking opioid receptors in specific neurons can restore breathing during an overdose

8/13/21


https://medicalxpress.com/news/2021-08- ... cific.html


It's long been known that opioid overdose deaths are caused by disrupted breathing, but the actual mechanism by which these drugs suppress respiration was not understood. Now, a new study by Salk scientists has identified a group of neurons in the brainstem that plays a key role in this process.

The findings, published June 8 in the journal Proceedings of the National Academy of Sciences, show how triggering specific receptors in these neurons causes opioid-induced respiratory depression, or OIRD, the disrupted breathing that causes overdose deaths. It also shows how blocking these receptors can cause OIRD to be reversed.

"The underlying mechanism of why opiates slow down and depress the breathing rhythm has not been fully characterized," says senior investigator Sung Han, assistant professor in Salk's Clayton Foundation Laboratories for Peptide Biology. "This knowledge can provide a stepping stone to better treatment options for OIRD."

The U.S. saw more than 93,000 overdose deaths in 2020, of which an estimated 60 percent were attributed to opioids like fentanyl. Opioids work by binding to proteins on nerve cells (neurons) called opioid receptors and subsequently inhibiting their activity. Currently, naloxone is the only medication known to block the effects of opioids and reverse an overdose. But naloxone has limitations, including a short duration that requires it to be administered multiple times. It also works systemically, blocking opioid receptors throughout the entire body, including those that control pain.

To develop strategies to rescue OIRD with more specificity, Han's team set out to search for the breathing neurons in the brain that also carry opioid receptors. In the new study, the researchers identified a group of neurons that express a certain type of opioid receptor (the mu opoid receptor) and are located in the brainstem breathing modulation center; they then characterized these neurons' role in OIRD.

They found that mice that were genetically engineered to lack opioid receptors in these neurons didn't have their breathing disrupted when exposed to morphine, as mice in the control group did. The researchers also found that, without introducing opioids, stimulating these receptors in control mice caused symptoms of OIRD.

The team then looked at ways to reverse the process by treating the overdosed mice with chemical compounds targeted to other receptors on the same neurons, which play an opposite role as the opioid receptor (activating rather than inhibiting them).

"We discovered four different chemical compounds that successfully activated these neurons and brought back the breathing rate during OIRD," said first author Shijia Liu, a graduate student in the Han lab. Recovery in overdosed mice was close to 100 percent, which surprised the team.

The researchers next plan to look at whether other cell groups also play a role in OIRD. Further study would also examine the connection between breathing regulation and pain perception in the brain, potentially opening the door to developing more targeted treatments for OIRD.

"We hope to explain the pain-breathing segregation at the molecular or microcircuit level," says Han, who holds the Pioneer Fund Development Chair. "By doing that, we can try to restore breathing without touching analgesic effects of opioids."

Other authors on the study are Dong-Il Kim, Tae Gyu Oh, Gerald M. Pao, Jong-Hyun Kim, Kuo-Fen Lee and Ronald M. Evans of Salk; Richard Palmiter of the University of Washington; and Matthew R. Banghart of the University of California San Diego.

More information: Shijia Liu et al, Neural basis of opioid-induced respiratory depression and its rescue, Proceedings of the National Academy of Sciences (2021). DOI: 10.1073/pnas.2022134118
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Study finds increasing disparities in opioid overdose deaths for Black people

9/9/21


https://www.news-medical.net/news/20210 ... eople.aspx


Non-Hispanic Black individuals in four U.S. states experienced a 38% increase in the rate of opioid overdose deaths from 2018 to 2019, while the rates for other race and ethnicity groups held steady or decreased, according to a new study by the National Institutes of Health published in the American Journal of Public Health. These alarming data are in line with other research documenting a widening of disparities in overdose deaths in Black communities in recent years, largely driven by heroin and illicit fentanyl. The research emphasizes the need for equitable, data-driven, community-based interventions that address these disparities.

The research was conducted as part of the HEALing Communities Study, which aims to significantly reduce opioid-related overdose deaths by helping communities implement evidence-based practices to treat opioid use disorder and reduce other harms associated with opioid use in New York, Massachusetts, Kentucky, and Ohio. It is the largest addiction implementation study ever conducted and is administered in partnership by NIH's National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration through the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative.

" We must explicitly examine and address how structural racism affects health and leads to drug use and overdose deaths. Systemic racism fuels the opioid crisis, just as it contributes mightily to other areas of health disparities and inequity, especially for Black people. We must ensure that evidence-based interventions, tailored to communities, are able to cut through the economic and social factors that drive disparities in substance use and addiction, to reach all people in need of services."

- Nora D. Volkow, M.D., NIDA Director

For this study, data were collected from death certificates for 2018 and 2019 across 67 communities with a total population of more than 8.3 million people in the four states participating in the HEALing Communities Study. The researchers calculated rates and trends of opioid overdose deaths overall and for each state, and then further analyzed trends by race and ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other). Overall, the investigators observed no change in the opioid overdose death rate in these states from 2018 (38.3 deaths per 100,000 people) to 2019 (39.5 deaths per 100,000 people).

However, the researchers observed a 38% overall increase in the opioid overdose death rate for non-Hispanic Black individuals from 2018 to 2019, across these four states. There were no changes overall among the other racial and ethnic groups. Trends varied at the state level and increases among non-Hispanic Black individuals were highest in Kentucky (a 46% increase) and Ohio (a 45% increase). The investigators did not observe a significant increase in Massachusetts among non-Hispanic Black individuals. While opioid overdose death rates were unchanged for non-Hispanic Black individuals in New York, there was an 18% decline among non-Hispanic white individuals, suggesting that non-Hispanic Black individuals have not benefitted equally from prevention and treatment efforts.

The study authors note that these data add to the evidence of increasing disparities in opioid overdose deaths by race and ethnicity, and highlight the importance of access to timely, local data to inform effective community-tailored strategies to reduce these deaths. Numerous evidence-based prevention and treatment interventions exist for addressing the opioid overdose crisis, overdose education and naloxone distribution, medications for opioid use disorder, behavioral therapies, and recovery support services. Unfortunately, these interventions have largely failed to gain widespread implementation in community settings including addiction treatment, general medical care, social support services, schools, and the justice system.

To address this challenge, the HEALing Communities Study is working with local, state, and federal partners to gain access to data on opioid-related overdose fatalities, treatment, and other related health concerns in a timelier fashion and include important demographic information including race and ethnicity. Early access to these data was instrumental in informing HEALing Communities Study intervention planning, including discussions ensuring evidence-based practices are equitably available to all racial and ethnic groups. For example, these data informed partnerships with Black community organizations to improve access to overdose education and naloxone distribution.

While the data presented here were critical in shaping public health response, the timeliness of data about drug use, addiction, and overdose is an ongoing challenge. National and state data are typically collected annually, access to the data is limited, and data may not be available for months. Health data related to race and ethnicity may be limited or completely unavailable, and mortality data are particularly lagged due to the time required for toxicology testing.

"The more local and timely data communities have access to, the more tailored their approach can be for interventions," said lead author Marc Larochelle, M.D., M.P.H., a general internal medicine physician at Boston Medical Center and assistant professor of medicine at Boston University School of Medicine. "We know there are disparities in implementation of effective strategies for reducing opioid overdose deaths, but early access to better data like these allows communities to address equity with improved intentionality."

The Helping to End Addiction Long-term Initiative, and NIH HEAL Initiative, are registered service marks of the U.S. Department of Health and Human Services.

Source:

National Institutes of Health

Journal reference:


Larochelle, M.R., et al. (2021) Disparities in Opioid Overdose Death Trends by Race/Ethnicity, 2018–2019, From the HEALing Communities Study. American Journal of Public Health. doi.org/10.2105/AJPH.2021.306431.
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Hospitalized patients with opioid use disorder die at a rate comparable to heart attack patients

9/15/21


https://www.news-medical.net/news/20210 ... ients.aspx


Hospitalized patients with opioid use disorder died at a rate comparable to those who suffered heart attacks within a year of hospital discharge, according to a new study from Oregon Health & Science University.

The study, published in the Journal of Addiction Medicine, found that almost 8% of patients with opioid use disorder died within 12 months of being discharged. Authors say their findings highlight the need for addiction care in the hospital, as well as generally improving health systems for patients with substance use disorders who also have other medical conditions.

" We need systems that can address comprehensive needs of people with substance use disorder and serious medical illness. That means trauma-informed systems that de-stigmatize addiction to make health care systems more trustworthy and more effective for our patients."

- Honora Englander, M.D., senior author, associate professor of medicine (hospital medicine) in the OHSU School of Medicine

Researchers went into the study knowing that people with opioid use disorder are seven times more likely to be hospitalized than the general population, but the new study is the first to characterize the rate at which these patients died a year after they leave the hospital.

Researchers reviewed data from a total of 6,654 Medicaid patients treated in 62 Oregon hospitals between April of 2015 and December of 2017.

Drug-related deaths, including overdoses, accounted for 58% of the 522 people who died within a year of being discharged from the hospital. The other deaths were attributed to causes other than drug-related, including diseases of the circulatory, respiratory and endocrine systems.

"A lot of the research has focused on overdose deaths," said lead author Caroline King, Ph.D., M.P.H., an M.D./Ph.D. student in the OHSU School of Medicine. "We found that overdoses are really just the tip of the iceberg for these patients, representing 13% of deaths in the year after discharge"

The rate of death was striking and surprising, she said.

A one-year death rate of 8% is similar to conditions like acute myocardial infarction, or heart attack.

"For heart attacks, hospital systems across the U.S. have universally accepted standards, metrics, and quality reporting that drives performance," Englander said. "The same should be true for opioid use disorder, where death rates are similar."

King said it's clear that health systems need to better integrate and destigmatize medical care these patients need, starting with easing access to proven addiction medications such as methadone and buprenorphine.

"It should be easier to access methadone than heroin," Englander said. "Right now, that is not the case – systems are such that people have to work so hard just to get life-saving treatment."

Source:


Oregon Health & Science University

Journal reference:


King, C., et al. (2021) Causes of Death in the 12 months After Hospital Discharge Among Patients With Opioid Use Disorder. Journal of Addiction Medicine. doi.org/10.1097/ADM.0000000000000915.
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Study finds rise in methamphetamine-involved overdose deaths from 2015 to 2019

9/22/21


https://www.news-medical.net/news/20210 ... -2019.aspx


Overdose deaths involving methamphetamine nearly tripled from 2015 to 2019 among people ages 18-64 in the United States, according to a study by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The number of people who reported using methamphetamine during this time did not increase as steeply, but the analysis found that populations with methamphetamine use disorder have become more diverse. Published today in JAMA Psychiatry, the study suggests that increases in higher-risk patterns of methamphetamine use, such as increases in methamphetamine use disorder, frequent use, and use of other drugs at the same time, may be contributing to the rise in overdose deaths.

" We are in the midst of an overdose crisis in the United States, and this tragic trajectory goes far beyond an opioid epidemic. In addition to heroin, methamphetamine and cocaine are becoming more dangerous due to contamination with highly potent fentanyl, and increases in higher risk use patterns such as multiple substance use and regular use. Public health approaches must be tailored to address methamphetamine use across the diverse communities at risk, and particularly for American Indian and Alaska Native communities, who have the highest risk for methamphetamine misuse and are too often underserved."

- Nora D. Volkow, M.D., NIDA Director, one of the study authors

In 2020, more than 93,000 Americans died from drug overdoses, marking the largest one-year increase in overdose deaths ever recorded, according to provisional data from the U.S. Centers for Disease Control and Prevention. This increase has largely been driven by rising overdoses involving synthetic opioids, primarily fentanyl. Overdose deaths involving psychostimulants, and particularly methamphetamine, have also risen steeply in recent years, and many of these deaths involved use of an opioid at the same time. However, questions remain on how trends in methamphetamine use contribute to greater risk for overdose deaths.

To address this gap, the study authors analyzed data on overdose deaths involving psychostimulants other than cocaine from cause of death files in the National Vital Statistics System from 2015 to 2019. They also assessed the methamphetamine use patterns of U.S. adults ages 18 to 64 - the age group at highest risk of substance use and overdose deaths - from the National Survey on Drug Use and Health (NSDUH), which provides annual information on tobacco, alcohol, and other drug use, mental health, and other health-related issues in the United States.

The researchers found that from 2015 to 2019, the number of overdose deaths involving psychostimulant drugs other than cocaine, (largely methamphetamine), rose from 5,526 to 15,489, a 180% increase. However, the number of people who reported using methamphetamine only increased by 43% over the same period.

In addition, the data show that people reporting frequent methamphetamine use (100 days or more per year) rose by 66% between 2015 and 2019, and people reporting the use of methamphetamine and cocaine together increased by 60% during this period. The researchers also found that since 2017, more people who reported using methamphetamine in the past year also reported higher-risk use patterns (i.e., had methamphetamine use disorder and/or injected methamphetamine) than reported lower-risk use patterns (i.e., did not meet criteria for methamphetamine use disorder and/or inject methamphetamine). These findings indicate that riskier use patterns may have contributed to the increased numbers of methamphetamine-involved overdose deaths during this time period.

The researchers also noted shifts in the populations using methamphetamine between 2015 and 2019. Whereas, historically, methamphetamine has been most commonly used by middle-aged white persons, this analysis found that American Indians/Alaska Natives had the highest prevalence of methamphetamine use, as well as methamphetamine use disorder and methamphetamine injection. Previous studies have found that American Indians/Alaska Natives also had the greatest increases in methamphetamine overdose deaths in recent years.

This analysis also found that prevalence of methamphetamine use disorder among those who did not inject the drug increased 10-fold among Black people from 2015 to 2019, a much steeper increase than among white or Hispanic people. Like frequency of use, methamphetamine use disorder is a measure used to capture escalating methamphetamine use. Methamphetamine use disorder without injection quadrupled in young adults ages 18 to 23, a substantially greater increase than in older age groups. This is of particular concern, as young adulthood is a critical period of continued brain, social, and academic maturation, and having methamphetamine use disorder during this vulnerable period could have long-lasting consequences.

Methamphetamine use has also been linked to HIV transmission, as infectious diseases can spread by sharing injection equipment and through heightened unprotected sexual activity that is often associated with methamphetamine use. Previous studies have reported high rates of methamphetamine use among men who have sex with men, who also face higher rates of HIV transmission. This study found that the prevalence of methamphetamine injection was the highest among homosexual men. Moreover, methamphetamine use disorder without injection more than doubled among homosexual or bisexual men. It also more than tripled among heterosexual women and lesbian or bisexual women, and more than doubled among heterosexual men, further emphasizing the expansion of use across different groups.

"What makes these data even more devastating is that currently, there are no approved medications to treat methamphetamine use disorder," said Emily Einstein, Ph.D., chief of NIDA's Science Policy Branch and a co-author of the study. "NIDA is working to develop new treatment approaches, including safe and effective medications urgently needed to slow the increase in methamphetamine use, overdoses, and related deaths."

Source:

National Institutes of Health

Journal reference:

Han, B., et al. (2021) Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults. JAMA Psychiatry. doi.org/10.1001/jamapsychiatry.2021.2588.
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Bobby Mukkamala, MD, on steps to address the overdose epidemic
Aug 31, 2021

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AMA statement on International Overdose Awareness Day

Aug 31, 2021


https://www.ama-assn.org/press-center/a ... reness-day


“On this day, we need to remember the hundreds of thousands of overdose deaths that have claimed our friends and family. This epidemic has been unsparing.

“As illicit fentanyl, methamphetamine and cocaine are making worse the nation’s overdose and death epidemic, the AMA is calling on policymakers and all public and commercial insurance companies to remove barriers to evidence-based care. Patients with pain and patients with a mental illness or substance use disorder have suffered enough. Ending this epidemic is possible, and the AMA is prepared to work with all stakeholders to implement proven solutions to improve outcomes and reduce death.”
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Raising her hand to help build U.S. addiction-medicine workforce

9/8/21


https://www.ama-assn.org/education/acce ... n-medicine


Board-certified addiction-medicine physician Cara Poland, MD, MEd, FACP, DFASAM, wanted her state of Michigan to train a future generation of physicians to treat substance-use disorders. But first, she realized, Michigan’s medical schools needed core faculty.

Like nearly every state in the country, Michigan is seeing staggering increases in overdose due to illicitly manufactured fentanyl, fentanyl analogs, methamphetamine and cocaine. Prescription opioid-related overdose and alcohol-use disorder also remain top issues in Michigan.

“In 2018, during a statewide meeting of the seven medical schools, I asked how many schools had core faculty to teach addiction. Only one did,” Dr. Poland said. “Now, almost all do. It sounds obvious, but you can’t train medical students in addiction if you don’t have trained faculty.”

Dr. Poland, an AMA member who is assistant professor of women’s health at Michigan State University, said that the 2018 meeting was eye-opening for everyone. The state had been working through multiple efforts to increase access to evidence-based treatment for substance-use disorders (SUDs), but it hadn’t considered the role of medical schools and residency programs.

“We had a blind spot, but we all had that aha moment when we realized we could do better for our communities if we just built it into the curricula,” said Dr. Poland, who was nationally selected to the inaugural class of addiction-medicine fellows at Boston Medical Center.

Given the relative lack of examples across the board, the Michigan physicians and deans realized that it was up to them to act. Through use of State Opioid Response funds, a collaboration was born: MI CARES.

Led by Dr. Poland, the program trains physician-level addiction specialists in Michigan and across the country. Nearly 400 physicians in 43 states are on the pathway to becoming board certified in addiction medicine. Michigan State University’s MD and DO medical schools also began implementing curricular changes to offer more training in treating persons with substance-use disorders to their medical students.


Related Coverage
Collaborative care model for mental health, addiction treatment

Student response has been overwhelmingly positive. Of the inaugural 36 first-year elective students taught by Dr. Poland and Jamie Alan, RPh, PharmD, PhD, all 36 stated that they would recommend the elective to a colleague.

“We didn’t figure it out overnight, but we’re on a great path. I also realize that not all of our students and residents will choose addiction medicine as their career,” said Dr. Poland, who is the principal investigator of multiple private and federally funded grants, including MI CARES, and a special interest grant, GREAT MOMs, treating pregnant people and their families living with a substance-use disorder.

“But all of them—whether they become surgeons, ob-gyns, family physicians, general internists or any other specialty—will be able to better serve their patients,” she added.

Dr. Poland emphasized that the training being done in Michigan builds on a foundation of medical evidence, nonstigmatizing practice, and the recognition that a patient with an SUD is like any other patient with a chronic disease. Follow-up surveys given to students are also helping Dr. Poland and other faculty evaluate the coursework and the students’ perceptions of patients with an SUD, the role of treatment and addiction medicine overall.

Among the students’ responses to the course, offered as an intersession:

Amazing intersession! Completely changed my mindset and understanding of patients with SUDs. The PCSS [Providers Clinical Support System] training we completed should be mandatory for all ECE [early clinical experience] students. Extremely valuable.
Dr. Alan and Dr. Poland are both extremely passionate about the topic, and it came through and made the class interesting and enjoyable.
This was fantastic! I absolutely loved this intersession, and Dr. Poland and Dr. Alan are amazing! They made the Zoom time together not only informative and engaging, but truly fun.
This was probably my favorite intersession and I can’t say enough positive things about it. Just keep it up! I appreciate the work that everyone put in to make this intersession possible.
This was the best intersession I have taken. The combination of patient care, board cases and training was great. Also, I wish Dr. Poland and Dr. Alan could teach all of my classes!

“I’m grateful for my co-faculty and the students who challenge themselves and are open to learning a field of medicine that is incredibly rewarding,” said Dr. Poland. “And as faculty, I need to learn how to continue to be better for my students. What we’re building at the medical school will resonate throughout the state, so we must always strive to improve.”

The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website, where a version of this article was initially published.

The End the Epidemic website was recognized by the Academy of Interactive and Visual Arts. As part of that organization’s 27th Annual Communicator Awards, End the Epidemic was honored with an Award of Excellence in the Cause & Awareness website category.
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Report shows decreases in opioid prescribing, increase in overdoses

Sep 21, 2021


https://www.ama-assn.org/press-center/p ... -overdoses


CHICAGO—The American Medical Association (AMA) issued a report (PDF) today showing a 44.4 percent decrease in opioid prescribing nationwide in the past decade. At the same time, the country is facing a worsening drug-related overdose and death epidemic.

To address this continuing epidemic, the AMA is urging policymakers to join physicians to reduce mortality and improve patient outcomes by removing barriers to evidence-based care. The report shows that overdose and deaths are spiking even as physicians have greatly increased the use of prescription drug monitoring programs (PDMPs), which are electronic databases that track controlled substance prescriptions and help identify patients who may be receiving multiple prescriptions from multiple prescribers. The report shows that physicians and others used state PDMPs more than 910 million times in 2020. In 2019, physicians and others used state PDMPs about 750 million times.

Yet, the nation continues to see increases in overdose mainly due to illicit fentanyl, fentanyl analogs, methamphetamine and cocaine, according to the U.S. Centers for Disease Control and Prevention. In addition, state public health, media and other reports compiled by the AMA (PDF) show that the drug-related overdose and death have worsened across the nation. Research and data from the National Institutes of Health, U.S. Substance Abuse and Mental Health Services Administration (PDF), and Indian Health Service underscore the continued challenges and inequities for Black, Latinx and American Indian/Native Alaskan populations.

Opioid prescriptions have decreased (PDF) by 44.4 percent between 2011-2020, including a 6.9 percent decrease from 2019-2020. Along with the sharp decreases in opioid prescriptions, new AMA data (PDF) also show that physicians and other health care professionals used the state PDMP more than 910 million times in 2020. The report also highlights that more than 104,000 physicians and other health care professionals have an “X-waiver” to allow them to prescribe buprenorphine for the treatment of opioid use disorder. This is an increase of 70,000 providers since 2017, yet 80 to 90 percent of people with a substance use disorder receive no treatment.

“The nation’s drug overdose and death epidemic has never just been about prescription opioids,” said AMA President Gerald E. Harmon, M.D. “Physicians, have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use PDMPs as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care.”
Actions that states can take

The AMA is urging policymakers to act now:

Stop prior authorization for medications to treat opioid use disorder. Prior authorization is a cost-control process that health insurance companies and other payers use that requires providers to obtain prior approval from the insurer or payer before performing a service or obtaining a prescription. It is used to deny and delay services—including life-saving ones—as physicians are required to fill out burdensome forms and patients are forced to wait for approval.
Ensure access to affordable, evidence-based care for patients with pain, including opioid therapy when indicated. While opioid prescriptions have decreased, the AMA is greatly concerned by widespread reports of patients with pain being denied care because of arbitrary restrictions on opioid therapy or a lack of access to affordable non-opioid pain care.
Take action to better support harm reduction services such as naloxone and needle and syringe exchange services. These proven harm reduction strategies save lives but are often stigmatized.
Improve the data by collecting adequate, standardized data to identify and treat at-risk populations and better understand the issues facing communities. Effective public health interventions require robust data, and there are too many gaps to implement widespread interventions that work.

“With record-breaking numbers of overdose deaths across the country, these are actions policymakers and other stakeholders must take,” Dr. Harmon said. “The medical community will continue to play its part, and overall, the focus of our national efforts must shift. Until further action is taken, we are doing a great injustice to our patients with pain, those with a mental illness and those with a substance use disorder.”


About the American Medical Association

The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care.
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Study reveals the trends in recreational ketamine use and availability in the U.S.

10/7/21

https://www.news-medical.net/news/20211 ... he-US.aspx


Recreational ketamine use and availability of the drug have increased in recent years, but it remains an uncommon drug used by less than 1 percent of people in the U.S., according to a new study published in the American Journal of Public Health.

Ketamine has long been used as an anesthetic in veterinary and health care settings, but ketamine is also a party drug that produces hallucinations and feelings of dissociation. In 2019, the Food and Drug Administration (FDA) approved the use of a nasal spray version of the drug as a fast-acting option for treatment-resistant depression.

" Since the approval of ketamine for psychiatric use, we've seen substantial attention and media coverage about the drug. As such, we wanted to determine whether there have been shifts in recreational ketamine use and availability."

-Joseph Palamar, PhD, MPH, study author, associate professor of population health at NYU Grossman School of Medicine and affiliated researcher with the Center for Drug Use and HIV/HCV Research at NYU School of Global Public Health

Palamar and his colleagues examined past-year recreational use of ketamine between 2006 and 2019 using the National Survey on Drug Use and Health, a nationally representative survey of U.S. teens and adults. They also looked at trends in ketamine-related poisonings between 1991 and 2019 as reported to poison control centers across the country. Finally, they examined trends in law enforcement seizures of ketamine, tracked by the Drug Enforcement Administration's National Forensic Laboratory Information System from 2000 to 2019.

Their results suggest an increase in recreational use and availability of ketamine in recent years-;particularly in 2019, coinciding with the drug's FDA approval for depression. However, despite these increases, its use has remained relatively rare, with less than 1 percent of teens and adults using the drug. The highest prevalence of recreational ketamine use-;0.9 percent-;was reported in late 2019.

Poisonings were highest in 2000-2001, which was also the peak in use of other club drugs such as MDMA (also known as ecstasy or Molly). "As a 'club drug,' ketamine use has always been closely linked with ecstasy use, which is also most likely to take place in nightlife settings," said Palamar. After a decline in poisonings, there was an increase again through 2014 to 1.1 poisonings per 1,000,000 people; this measure has remained relatively consistent since.

Rates of ketamine seizures by law enforcement have increased exponentially since 2012, although seizures are still uncommon relative to other drugs. The proliferation of seizures suggests an increase in the drug's availability.

"Increases in ketamine use in nightclub and non-hospital settings indicate the need for additional public health measures so that individuals who use non-medically are aware of risks and side effects," said Katherine Keyes, PhD, associate professor of epidemiology at Columbia University Mailman School of Public Health, and co-author.

"While ketamine is used medically throughout the world, it is important for surveillance efforts to focus on recreational use in an effort to inform prevention and harm reduction programs," added Palamar.

Source:

New York University

Journal reference:


Palamar, J.J., et al. (2021) Trends in Ketamine Use, Exposures, and Seizures in the United States. American Journal of Public Health. doi.org/10.2105/AJPH.2021.306486.
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Mental health problems are common among smokers and adults with substance use disorders, study finds

10/21/21


https://www.news-medical.net/news/20211 ... finds.aspx


Mental health problems are common among adults who smoke cigarettes and those with substance use disorders, illustrating a need for treating smoking and mental health problems together, according to a new study by Indiana University.

The research, done in conjunction with other universities, found mental health problems were more than twice as common among adults with substance use disorder who smoke cigarettes compared to those without substance use disorder who do not smoke cigarettes.

" Our study shows that there is a need for consistency in treating mental health, smoking and substance use problems together. Smoking cessation does not undermine progress made in mental health or substance use treatment programs."

- Maria Parker, assistant professor, IU School of Public Health-Bloomington and lead author of the study

The study, published in Drug and Alcohol Dependence journal, used data from the United States National Survey on Drug Use and Health. The prevalence of mental health problems (i.e., serious psychological distress) was estimated over 10 years for adults who had current daily, current non-daily, former and never cigarette smoking by substance use disorder status.

Mental health problems continue to increase in the U.S. and is associated with negative health consequences including premature mortality and chronic health conditions.

"It is critical that we identify groups with higher prevalence of mental health problems that could be targeted for interventions," Parker said.

The study found serious psychological distress varied significantly by substance use disorder status and cigarette smoking status, such that serious psychological distress was between three and five times higher for those with substance use disorder compared to those without across all smoking statuses.

These patterns were found for nearly every sex, age, race/ethnicity, income and marital status subgroup. The prevalence of serious psychological distress was highest for those with substance use disorder and daily cigarette smoking, with a quarter or more of these adults reporting distress.

The study also found that serious psychological distress increased over time for all smoking statuses, and increases over time were higher for people with substance use disorder than those without.

Parker said to address cigarette smoking and substance use disorder for those with mental health problems, incorporating a broad psychiatric symptom assessment into cigarette smoking cessation or substance use disorder treatment programs may be beneficial. Additionally, when assessing and treating individuals for cigarette smoking and substance use disorder, providers might screen for psychiatric symptoms.

Source:

Indiana University

Journal reference:


Parker, M.A., et al. (2021) Intersectionality of serious psychological distress, cigarette smoking, and substance use disorders in the United States: 2008–2018. Drug and Alcohol Dependence. doi.org/10.1016/j.drugalcdep.2021.109095.
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