Category: Addiction

Categories : Addiction COVIDTags :

Opioid Overdoses in US Increasing due to COVID

On By ModernMedia

The COVID pandemic has not seen a drop in the United States’ opioid crisis, rather there has been an exacerbation of the problem.

A study published in JAMA Psychiatry examined the impact that the COVID pandemic had on the US opioid crisis. 

Opioid misuse and addiction is an ongoing and increasing problem in the US, making up two thirds of overdoses. Some three million Americans have suffered opioid use disorder at some point. With approximately 100 million Americans living with chronic or acute pain, the situation is seemingly intractable. In 2019, there were 70 000 deaths from opioid overdoses, making it a top priority in public health, academic, and political debates. When the COVID pandemic hit, it did not displace the opioid crisis through distraction or somehow preventing access to opioids, it fanned the flames of it. 

Researchers analysed 190 million ED visits, and over March to October 2020. they observed an increase of  up to 45% in weekly opioid overdose admissions over the same period in 2019. Overall, ED visits for opioid overdoses had increased 28.8% compared to the previous year.

In September, the CDC warned that deaths from opioid overdoses were up by 38.4% in the first half of the year. The many stresses of the pandemic, such as its associated lockdowns and job losses and losing loved ones, has fuelled the opioid abuse. The same study also found that visits to the ED for mental health conditions, domestic violence, and child abuse and neglect increased over the same period of time, along with suicide attempts. 

Source: ABC News

Journal information: Holland KM, Jones C, Vivolo-Kantor AM, et al. Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic. JAMA Psychiatry. Published online February 03, 2021. doi:10.1001/jamapsychiatry.2020.4402

Categories : Addiction PaediatricsTags :

Misuse of Psychiatric Meds Common in Teens

On By ModernMedia

A study into the use and misuse of psychoacttive drugs by US teens has found that about a fifth report misusing their prescribed medications.

Israel Agaku, PhD, of Harvard School of Dental Medicine in Boston, and colleagues used data from a survey of adolescents aged 12-17 prescribed opioids, stimulants, tranquilizers, or sedatives, and found that 20.9% reported using them not as prescribed or directed. There has been considerable concern in recent years over whether adolescents in the United States were being overprescribed psychiatric medication, although a 2018 study concluded that they are not. However, as with adults, the prospect of misuse, possibly leading to substance use disorders is a concern.
Of these youths, 3.4% reported having substance misuse disorders, and this proportion increased to nearly half when youths were taking two or more prescribed medications.

Some 25% of 12-17 year olds reported receiving a psychiatric prescription in the past year. The most common psychoactive prescription in the past year was opioids in 19% of all youth, followed by stimulants (7.2%), tranquilisers (4.3%), and sedatives (2.2%). Tranquilisers were the most commonly misused (40.1%), with substance use disorder in 7%. Stimulants were misused by 24.2%, 3% having a substance use disorder.
Among adults aged 18-25, 41% had been prescribed and had used psychoactive medication, with a third saying they had used opioids in the past year, Similarly to the 12-17 age group, stimulants and tranquilisers were most likely to be misused. 

“The largely overlapping population profiles for medical use versus misuse indicates the high abuse liability of these prescription substances,” the researchers noted. “Having serious psychological distress was consistently associated with misuse of every assessed psychoactive prescription medication.”

The researchers suggested that an open-minded, collaborative approach by healthcare providers was the best approach to dealing with the situation.

“Rather than asking only about cigarette smoking, pediatric practitioners should screen for different commonly used substances, including ‘social use.’ Specifically asking youth and young adults if they have used certain substances, including occasional use, is important as those who use such substances infrequently or only occasionally may not self-identify as users if asked in generic terms,” the researchers explained.

Source: MedPage Today

Journal information: Agaku I, et al “Medical use and misuse of psychoactive prescription medications among US youth and young adults” Fam Med Com Health 2021; DOI: 10.1136/ fmch-2020-000374.

Categories : Addiction Pain ManagementTags :

Opioid Deaths Drop when Cannabis Stores are Near

On By ModernMedia

A new US study suggests that opioid-related mortality rates fall in counties where there are legal cannabis stores.

Cannabis was first legalised for medical use in the US in 1996; recreational legalisation began in 2012 with a number of states following suit. Previous research on the effect of legal access to cannabis on opioid overdose mortality had produced conflicting results, with a 2014 study showing a slow increase in deaths, but a subsequent study showing that it reversed over time.

Data on opioid mortality for adults 21 and over was drawn from 2014-2018 CDC data, and a website called Weedmaps for cannabis dispensary details in the 23 states plus the District of Columbia where cannabis dispensaries were allowed to operate as of 2017.

The number of cannabis dispensaries in a county was negatively related to log-transformed age-adjusted opioid mortality rate (β -0.17, 95% CI -0.23 to -0.11). An increase in the number of storefront dispensaries from one to two was linked to a 17% reduction in death rates of all opioid types, and an increase from two to three stores was associated with a further 8.5% drop in mortality.

Eight states plus the District of Columbia allowed recreational storefronts and 15 allowed only medical dispensaries. An increase in medical dispensaries from one to two resulted in a 15% drop in mortality rate; an increase in recreational dispensaries from one to two led to an 11% drop.

Co-author Balázs Kovács, PhD, of Yale University School of Management, said: “We find this relationship holds for both medical dispensaries, which serve only patients who have a state-approved medical card or doctor’s recommendation, as well as for recreational dispensaries, which sell to adults 21 years and older.”

An accompanying editorial pointed out that the relationship was not clear, noting that were was no evidence of substitution. Additionally, individual experiences of benefits and harms could not be inferred.

Although findings are suggestive of a possible link between the increased prevalence of cannabis dispensaries and reduced opioid-related mortality, they do not show causality, Kovács emphasised. “While we find a particularly strong association between the prevalence of storefront dispensaries and fentanyl-related opioid deaths, it is not clear whether cannabis use and fentanyl mortality rates are more specifically linked, or if the strength of the association is due to the rise in fentanyl use and mortality rates during the study period,” he said. 
He added that the potential harms of cannabis, including cognitive development of adolescents, schizophrenia and other medical conditions, and public safety risks, should not be ignored.
Source:MedPage TodayJournal information:  Hsu G and Kovács B “Association between county level cannabis dispensary counts and opioid related mortality rates in the United States: panel data study” BMJ 2021; DOI: 10.1136/bmj.m4957.

Categories : Addiction Pain ManagementTags :

New Study Challenges the Need for Some Post-surgical Opioids

On By ModernMedia

Doctors must carefully weigh the pain relief value of opioids for patients against their potential for misuse and inducing opioid addiction even in patients with no history of substance abuse. Now, a new study challenges current practice by showing the effectiveness of an approach that takes a middle way to giving opioids.

Some 16 million people around the world suffer from opioid use disorder, which can result from opioid administration from surgery and for chronic pain. Opioids are highly addictive, with tolerance reached in days and addiction can occur within a matter of weeks, so there is every incentive to minimise exposure of patients to these effective but potentially dangerous medications.

To investigate the effectiveness of minimising opioid use, a team from Michigan Medicine at the University of Michigan conducted a study with 620 patients who had surgery in hospitals across Michigan, had their anaesthetic usage tracked, and filled in surveys within one to three months following their surgeries. The patients were split equally into two groups.
The first group received pre-surgery counseling emphasising non-opioid pain treatment as their first option. Some patients in this group received small, “just in case” prescriptions, but a third of them didn’t receive any opioid prescription at all after surgery.

The patients in the other group received standard care, that is, receiving the usual amount of opioids prescribed after such operations. The prescriptions received in fact were larger than in the opioid sparing group. Most patients didn’t take all of the pills, which if left lying around could be used inappropriately.

Patients in the two groups had the same surgery: either gallbladder removal, full or partial thyroid removal or hernia repair. However, both groups reported equal levels of quality of life and satisfaction with care when followed-up. Most surprisingly, the opioid-sparing group reported less pain overall.

First author Maia Anderson, MD, a resident in the U-M Department of Surgery, said: “It’s so exciting to think about the potential for opioid sparing postoperative pathways to not only reduce the risk of opioids for our patients, but also to substantially decrease the risk of opioid diversion into our communities.”

Senior author Ryan Howard, MD, Surgical Resident, Michigan Medicine commented: “We know that opioids pose serious risks to patients after surgery. We can protect patients from those risks by reducing or eliminating opioids after surgery. But that idea always raises the concern that patients will have uncontrolled pain and feel miserable. This study suggests that’s not the case – patients who get small opioid prescriptions, or even no prescription, are just as satisfied with their recovery after surgery.”

Source: News-Medical.Net

Journal information: Anderson, M., et al. (2020) Patient-Reported Outcomes After Opioid-Sparing Surgery Compared With Standard of Care. JAMA Surgery. doi.org/10.1001/jamasurg.2020.5646.

Categories : Addiction Mental HealthTags :

Happier Memories in Teens Linked to Less Alcohol and Marijuana Use

On By ModernMedia

A study of teenage American students has found that happy childhood memories, along with a positive view of the present and outlook for the future are associated with reduced alcohol use, binge drinking and marijuana use. 

Researchers say that action is needed because COVID restrictions have left teenagers isolated and vulnerable. Quarantining results in anxiety, stress and feelings of loneliness in children and adolescents, and the closure of schools has also taken away mental health support systems which some teenagers may rely on.

John Mark Froiland of Purdue University said: “School often seems a source of stress and anxiety to students. This puts them at greater risk of not participating in lessons, getting lower grades and of substance misuse. Many teenagers also aren’t engaging with online learning during Covid or have lower engagement levels.

“But they’re more likely to be enthusiastic learners and not use drink and drugs if teachers take time to build more positive relationships with them. They can help students see that everything they’re learning is truly valuable. Parents have a role to play too.”

The study was based on questionnaires completed by 1961 student participants in San Francisco, of which 53% were female. The researchers examined how happy the students believed their childhood was, how happy they were currently and how optimistic they were about their futures.

In addition, they looked at alcohol and marijuana use over the past 30 days and binge use, as well as academic grades, behaviour during lessons and motivation.

Positive attitudes towards the past, present and future was associated with lower alcohol use, binge drinking and marijuana use, while the reverse was true for negative attitudes.

An optimistic outlook increased the likelihood that they would be motivated and focus on learning. Other findings included drinking being associated with marijuana use, and that girls had better behavioural engagement than boys.

Source: News-Medical.Net

Journal information: Froiland, J.M., et al. (2020) Positive and negative time attitudes, intrinsic motivation, behavioral engagement and substance use among urban adolescents. Addiction Research & Theory. doi.org/10.1080/16066359.2020.1857740.

Categories : AddictionTags :

Withdrawal Symptoms of Discontinuing Medical Cannabis

On By ModernMedia

A new study on the long terms effects of having used medical cannabis show that over half of people who used it experience withdrawal symptoms between use. And about one in ten experienced worsening alterations in sleep, mood, mental state, energy and appetite over two years.

Patients who use cannabis usually turn to it because of the failure of other pain medications, or to avoid the long-term risks of opioid use. However, the perception that it is “harmless” is incorrect, as it has cannabinoids that act on receptors in the brain, and from which the brain can experience withdrawal symptoms. This can even lead to cannabis use disorder.

Addiction psychologist Lara Coughlin, PhD, who led the analysis said, “Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time.”

After they had gone a significant time without cannabis, the 527 participants in the study were asked whether they had any one of 15 symptoms, ranging from irritability to nausea. Using an analytic method, they empirically grouped them into three groups ranging from mild or moderate symptoms to severe, with most of the symptoms. They then surveyed the patients again after one year and then again after two years. Those in the mild class showed the most stability in symptoms over time.

Younger participants were more likely to be in the severe group, and were more likely to have a worsening trajectory. Coughlin concluded that patients seeking cannabis use for pain need to discuss it with their health care providers, and seek psychosocial treatments such as cognitive behavioural therapy.

Source: Medical Express

Journal information: Coughlin, LN et al. Progression of cannabis withdrawal symptoms in people using medical cannabis for chronic pain. Addiction. 2021. DOI: 10.1111/add.15370

Categories : Addiction CancerTags :

Nearly a Fifth of Cancer Patients on Opioids Misuse Them

On By ModernMedia

A new report reveals that 19% of cancer patients receiving opioids are misusing them, referred to a nonmedical opioid use (NMOU) behaviour. 

Opioid addiction remains a persistent and serious problem in the United States, and is growing elsewhere in the world, with some 16 million individuals worldwide suffering from opioid misuse disorder.
The study,  led by Sriram Yennurajalingam, MD, MS, of MD Anderson Cancer Center in Houston, included 1554 patients at a supportive care clinic for a comprehensive cancer centre. Of those engaging in NMOU behaviour, the most common (29%) was an early request for a refill, followed by self-directed dose escalation (15%), co-using illicit or non-prescribed drugs (13%), and impaired daily function due to opioids (11%).

Independent risk factors that increased the risk of NMOU behaviour included being single or divorced, as well as pain levels, opioid risk screening score, and morphine equivalent daily dose.

In their recommendations, Yennurajalingam and co-authors wrote: “Based on these findings, a universal screening, setting limits on opioid use by limiting supply, more intense follow-up with an interdisciplinary team to provide optimal use of medications for pain and symptom management, and the provision of counseling and support to patients and their family members may help prevent the development of these NMOU behaviors.”

Source: MedPage Today

Journal information: Yennurajalingam S, et al. Frequency of and factors associated with nonmedical opioid use behavior among patients with cancer receiving opioids for cancer pain, JAMA Oncol 2020; DOI: 10.1001/jamaoncol.2020.6789.

Categories : AddictionTags :

Il-10 Found to be Involved in Alcoholism

On By ModernMedia

Researchers have discovered that the anti-inflammatory IL-10 plays a direct role in alcoholism. Neurological research into addiction and alcohol has focused on the amygdala, which plays a key role in drives, emotions and behaviours.

Alcoholism is a growing problem in need of effective treatment. Interleukin 10 (IL-10) is an immune protein that has strong anti-inflammatory properties and is known to protect the brain from inflammation resulting from disease or injury.

In the brains of mice which chronically used alcohol, the amount of IL-10 was lowered in the amygdala and did not correctly signal neurons, and so was partly responsible for alcohol consumption behaviours. This was despite the overall higher level of IL-10 throughout the brains of chronic alcohol using mice.

“We found that chronic alcohol exposure compromises brain immune cells, which are important for maintaining healthy neurons,” said first author of the study Reesha Patel, PhD. “The resulting damage fuels anxiety and alcohol drinking that may lead to alcohol use disorder.”

The researchers counteracted the decrease of IL-10 amounts and signalling in mice, and the mice’s excessive alcohol use declined, and a decrease in anxiety was also noted.

Marisa Roberto, PhD, a professor in Scripps Research’s Department of Molecular Medicine, led the research. She said, “We’ve shown that inflammatory immune responses in the brain are very much at play in the development and maintenance of alcohol use disorder. But perhaps more importantly, we provided a new framework for therapeutic intervention, pointing to anti-inflammatory mechanisms.”

Source: Medical Xpress