Category: From Newswise – Addiction

For nearly five years, people with attention deficit/hyperactivity disorder have had the option of getting their stimulant medications prescribed and renewed by doctors they see only over a computer screen, despite the risks that these stimulant drugs can pose if misused.

But with expiration dates coming up for the telehealth rules that made this possible, a new study offers key evidence about the safety of virtual ADHD care that could inform policymakers.

Published in the journal Health Affairs by a team from the University of Michigan, the study shows people aged 12 to 64 who started getting stimulant medications via telehealth were slightly more likely to develop a substance use disorder (SUD, also sometimes called addiction) within the next year than those who started getting the medications via in-person care. The risk in these two groups was 3.7% versus 3.2%.

However, for the entire study population of 12- to 64-year-olds, the higher risk disappeared when accounting for the fact that people using telehealth to start stimulant therapy were also more likely to have mental health conditions, such as depression. These conditions are strong risk factors for SUD.

But the study finds one group – adults between the ages of 26 and 34 who started their ADHD stimulant medications through telehealth – did have a higher risk of SUD even after accounting for mental health conditions.

“Although there appeared to be an increased risk of substance use disorder among patients who initiated their ADHD stimulant medication through telehealth, when we accounted for psychiatric diagnoses that also increase risk, the difference disappeared except for those aged 26 to 34,” said Joanne Constantin, Ph.D., the study’s lead author and a postdoctoral research fellow at the Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, based in the U-M Medical School’s Department of Pediatrics.

The fact that young adults are largely no longer able to be covered by a parent’s health insurance after age 26 may play a role, said Constantin. “Young adults are more independent about getting their own medication without parental supervision, which highlights the importance of screening and monitoring for this age group.”

The researchers conclude that screening for addiction risk and monitoring for signs of SUD on an ongoing basis could be important to include in any future policies regarding telehealth-based ADHD care.

Current federal telehealth rules allow behavioral health care without an in-person visit to continue through December 31.

That’s in addition to other policies designed to prevent misuse and diversion of stimulant drugs used for ADHD, which are specially regulated controlled substances. Such drugs, sold under names such as Ritalin and Adderall, now carry strong warnings from the U.S. Food and Drug Administration about potential risks from misuse.

“Telehealth can be an essential way to access care, but this study suggests an ongoing need to balance such access with protecting safety, through guidelines for providers about screening and follow-up,” she adds.

Constantin worked with Michigan Medicine pediatrician and health care researcher Kao-Ping Chua, M.D., Ph.D., a member of CHEAR, on the study.

Current ADHD prescribing climate

To prescribe stimulants for ADHD, clinicians must be licensed by the U.S. Drug Enforcement Agency and often need to check their state’s prescription drug monitoring program records to see the patient’s history of receiving medications that are controlled because of their risk of misuse.

But there are no specific guidelines for screening for SUD risk factors at the start of treatment or monitoring patients for SUDs on an ongoing basis, beyond the FDA “black box” warning.

That warning focuses not just on the potential risk of using ADHD stimulant medication in different ways than prescribed but also the risks to people without ADHD whom the patient might give or sell their medication to.

Several companies have started offering standalone ADHD care entirely via telehealth during the past five years, after the insurance requirements for virtual care became much more flexible due to the COVID-19 pandemic.

Some of those companies have been the subjects of criminal and non-criminal proceedings from state law enforcement, because of alleged lack of oversight of how the stimulants their clinicians prescribe are used.

More about the study

The study used data from anonymous health insurance records from people with private insurance or Medicaid coverage. It included 77,153 people who had not received stimulant ADHD medication or an SUD diagnosis in the past year, and who started on a stimulant in 2021.

The researchers then looked at the records for the same people over the year after they got their first stimulant prescription, to see if they were diagnosed with an SUD of any kind.

More than 21,000 of the patients started on their stimulant via a telehealth visit, while the rest started via an in-person visit. Those starting via telehealth were much more likely to also have a diagnosis of anxiety, depression and/or another psychiatric condition in their records. So, the researchers adjusted for this difference, and for other differences between the two populations, in their analysis.

In addition to Constantin and Chua, the study’s authors are Sean Estaban McCabe, Ph.D., and Emily Pasman, Ph.D., LMSW, of the U-M School of Nursing, and Timothy Willens, M.D., chief of child and adolescent psychiatry and co-director of the Center for Addiction Medicine at Massachusetts General Hospital.

McCabe directs the U-M Center for the Study of Drugs, Alcohol, Smoking and Health, also called the DASH Center. McCabe and Chua are members of the U-M Institute for Healthcare Policy and Innovation.

Chua has consulted for the U.S. Department of Justice on unrelated topics.

Association Between Telehealth Initiation of Stimulant Therapy And New Substance Use Disorder Diagnoses, Health Affairs, DOI:10.1377/hlthaff.2024.01026

Researchers at the Herbert Wertheim School of Public Health and Human Longevity Science and Moores Cancer Center at University of California San Diego have found that, among smokers in the United States, e-cigarette use does not increase smoking cessation and is actually associated with reduced tobacco abstinence. The findings, published March 5 in JAMA, refute the notion that e-cigarettes can help people quit, a common misperception among tobacco users and e-cigarette proponents.

“Most smokers think vaping will help you quit smoking,” said study co-author John P. Pierce, Ph.D., Distinguished Professor in the Herbert Wertheim School of Public Health. “However, this belief is not supported by science to date. While some researchers have suggested that smokers who switch to daily vaping will be more successful in quitting smoking, We studied quitting success among both daily and non-daily vapers and came up with a quite definitive answer.”

The new study analyzed data from over 6,000 U.S. smokers from the Population Assessment of Tobacco and Health Study, a nationally representative sample of U.S. cigarette smokers. There were 943 smokers who also vaped and by matching and comparing these to similar smokers who didn’t vape, they found:

• Smoking cessation was actually 4.1% lower among smokers who vaped daily.
• Similarly, smoking cessation was 5.3% lower among smokers who vaped, but not daily, compared to matched smokers who did not vape.

According to the CDC, almost 20% of people in the U.S. use tobacco products. While the majority of these people are cigarette smokers, some people have switched from smoking to vaping in recent years, in part because vaping is generally perceived as less harmful. This perception contributes to the belief among many smokers that vaping is an effective way to “taper off” of cigarettes.

Considering the potential dangers of vaping, the researchers note that while e-cigarettes don’t have the same health consequences as smoking, they are not harmless.

The adverse health effects of cigarette smoking become obvious after people have smoked for 20 years,” added Pierce, a former director for population sciences at Moores Cancer Center. “While vapes generally don’t contain the same harmful chemicals as cigarette smoke, they have other risks, and we just don’t yet know what the health consequences of vaping over 20 to 30 years will be.”

One unique strength of the study is that the researchers were able to control for a wide range of other variables that are well-known to be associated with quitting, including whether they were non-daily cigarette smokers, interest in quitting (including a recent quit attempt), the presence of a smoke-free home, and socioeconomic factors.

“For example, if a smoker is already very interested in quitting, has a smoke-free home, and does not smoke daily, they are much more likely to successfully quit regardless of whether they vape or not,” said senior author Karen Messer, Ph.D., professor of biostatistics in the Herbert Wertheim School of Public Health. “We matched each smoker/vaper on such characteristics. You have to make very sure you’re comparing like with like, and that’s why this analysis is so definitive.”

According to the researchers, failing to adequately account for these confounding factors in previous studies is part of why misconceptions about e-cigarettes have persisted so long.

“As the public health community continues to grapple with the complexities of tobacco control, it is essential that we rely on rigorous scientific evidence to inform our policies and interventions,” added Messer, who is also director of the Biostatistics Shared Resource at Moores Cancer Center. “Our research shows that misleading associations between vaping and smoking cessation routinely occur unless confounding characteristics are carefully accounted for.”

In addition to providing definitive evidence about a contentious question in tobacco research, the study’s results have important implications for public health policy and practice surrounding e-cigarettes, particularly how they are marketed to adolescents, for whom e-cigarettes are often a gateway to nicotine dependence.

“There’s still a lot we don’t know about the impact of vaping on people,” said Natalie Quach, a third-year biostatistics Ph.D. student at the Herbert Wertheim School of Public Health and the study’s first author. “But what we do know is that the idea that vaping helps people quit isn’t actually true. It is more likely that it keeps them addicted to nicotine.”

Co-authors of the study include: Jiayu Chen, Brian Dang, Matthew D. Stone, David R. Strong, Dennis R. Trinidad and Sara B. McMenamin, all at UC San Diego.

This project was supported by the Tobacco-Related Disease Research Program (TRDRP) of the University of California Office of the President (T31IR-1584 & T32IR-4988).

# # #

Disclosures: The authors report no conflicts of interest.

PHILADELPHIA (February 26, 2025) – Imagine a future where the grip of cocaine use disorder can be loosened, where cravings fade, and the risk of relapse diminishes. A new study published in Science Advances, led by Penn Nursing’s Heath Schmidt, PhD, brings this vision closer to reality. The research has identified a critical brain circuit that plays a pivotal role in regulating cocaine-seeking behavior.

Cocaine use disorder casts a long shadow, trapping individuals in a cycle of dependence and leaving limited options for effective treatment. This study delves deep into the brain, offering crucial insights into the underlying mechanisms of this complex disorder. By understanding how this intricate circuitry functions, scientists can pave the way for the development of more effective therapies, offering new hope to those struggling with this debilitating disorder.

At the heart of this discovery lies the role of glucagon-like peptide-1 (GLP-1), a hormone known for its involvement in regulating food intake and blood sugar. The study reveals that chronic cocaine use is associated with reduced GLP-1 levels, effects that suggest that increasing central GLP-1 signaling could reduce cocaine seeking.

Further investigation pinpointed a specific brain circuit: GLP-1-producing neurons in the nucleus tractus solitarius (NTS) that project to the ventral tegmental area (VTA), a key brain region involved in reward and motivation. By manipulating this circuit, researchers were able to significantly reduce cocaine-seeking behavior in animal models.

The study also sheds light on the specific cells involved. GLP-1 receptors were found to be primarily located on GABA neurons within the VTA. GABA, an inhibitory neurotransmitter, plays a crucial role in regulating brain activity. Importantly, activating these GLP-1 receptors increases the activity of GABA neurons, which in turn reduces the activity of dopamine neurons, a key neurotransmitter involved in reward and addiction.

“This research provides exciting new insights into the brain mechanisms underlying cocaine seeking,” said Schmidt, the Killebrew-Censits Chair of Undergraduate Education and a Professor of Neuroscience and Pharmacology in the Department of Biobehavioral Health Sciences. “By understanding how GLP-1 signaling influences brain activity in this context, we can potentially develop new GLP-1-based treatments to treat cocaine use disorder.”

This research opens a new chapter in the fight against cocaine use disorder. The findings offer a promising avenue for developing innovative therapies that target this critical brain circuit, potentially offering a lifeline to individuals struggling to break free from the grip of this devastating disorder.

# # #

About the University of Pennsylvania School of Nursing

The University of Pennsylvania School of Nursing is one of the world’s leading schools of nursing. For the ninth year in a row, it is ranked the #1 nursing school in the world by QS University. Our Bachelor of Science in Nursing (BSN) is among the top ranked programs in the nation according to the 2025 U.S. News & World Report’s Best Colleges rankings. Our School also consistently ranks highly in the U.S. News & World Report annual list of best graduate schools and is ranked as one of the top schools of nursing in funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: Facebook, X, LinkedIn, YouTube, & Instagram.

Media Contacts: Katelyn Deckelbaum, [email protected] or Kathy Fackelmann, [email protected]

Newswise — WASHINGTON (Feb. 20, 2025)–A new study analyzes the disease burden and the risk factors for severity among people who suffer from a condition called cannabinoid hyperemesis syndrome. Researchers at the George Washington University say the condition occurs in people who are long-term regular consumers of cannabis and causes nausea, uncontrollable vomiting and excruciating pain in a cyclical pattern that often leads to repeated trips to the hospital.

“This is one of the first large studies to examine the burden of disease associated with this cannabis-linked syndrome,” says Andrew Meltzer, professor of emergency medicine at the GW School of Medicine & Health Sciences and lead author of the study. “Our findings suggest that cannabinoid hyperemesis syndrome could represent a costly and largely hidden public health problem.” While the exact prevalence of the condition is unknown, many experts say that the condition is on the rise as the number of daily or near daily users of cannabis has increased in the US.

To assess the burden of disease, Meltzer and his colleagues conducted a survey of 1,052 people who report suffering from cannabinoid hyperemesis syndrome. The researchers asked questions about frequency of use, duration of the habit, the age they started using the drug, and need for emergency department or hospital care. 

Key findings of the study:

• 85% reported at least 1 emergency department visit and 44% reported at least 1 hospitalization associated with the hyperemesis symptoms.
• Early age of cannabis initiation was associated with higher odds of emergency department visits.
• Daily use of cannabis before the onset of the syndrome was nearly universal, with over 40% of respondents reporting they used marijuana more than 5 times a day.
• Prolonged use was common with 44% reporting using regularly for more than 5 years before onset of syndrome.

The new research suggests that the condition may impose a heavy burden on individuals who suffer from it as it often results in pain, vomiting and costly trips to the hospital.  Emergency room doctors can stabilize the patient and help alleviate the acute symptoms but the only known way to stop the episodes of excruciating abdominal pain and repeated vomiting is to stop using cannabis, Meltzer says.

Although this study had some limitations, including self reported use of cannabis, Meltzer says it suggests a substantial risk of this painful and costly condition, especially for users who begin daily use of cannabis as adolescents. He says more research is needed to understand why some people suffer from the condition after prolonged cannabis exposure and others do not. In addition, it is unclear why cannabis changes from a drug that has been known to ease nausea and vomiting, especially among patients undergoing chemotherapy, to causing nausea and vomiting in a subset of people. 

Meltzer says it is important for clinicians to advise those with frequent cannabinoid use or hyperemesis about the risks and subsequent disease burden. He says many patients don’t realize that the syndrome is connected with their use of cannabis. Physicians should explain that and advise patients on resources to help them quit, he says.

The study, Cannabinoid Hyperemesis Syndrome is Associated with High Disease Burden: An Internet-based Survey, was published in the Annals of Emergency Medicine on Feb. 20, 2025.

Andrew Meltzer explains more about the study in this GW video.

-GW-

WHO:                                                

Founded in 1952, the American Counseling Association is the world’s largest association representing more than 60,000 professional counselors.

WHAT:                                              

The 2025 ACA Conference & Expo is the premier professional development and networking event for professional counselors.

WHERE:                                            

Hyatt Regency Orlando & Orange County Convention Center

WHEN:                                              

March 27-29, 2025

MEETING HIGHLIGHTS:               

Conference highlights include the following:

• Opening keynote: Brandon Wolf, survivor of the 2016 shooting at Orlando’s Pulse Nightclub; national press secretary, Human Rights Campaign; and nationally recognized advocate for LGBTQ+ civil rights and gun safety
• 3 featured speakers: Jeanette Betancourt, senior vice president, U.S. Social Impact, Sesame Workshop; Samirah Horton, CEO and founder of You Are Never Too Young to Make a Change; and Tommie Mabry, international speaker, educator and author
• 200+ education sessions, organized across 24 mental health and counseling topic areas, such as aging, ethics and legal issues, substance use and addiction, suicide, wellness and self-care, and more
• 4 poster sessions featuring more than 150 posters

INTERVIEWS/REGISTRATION:    

Media interested in setting up an interview with an ACA spokesperson or counselor or looking for more information on attending in person, please contact Karen Addis at 301-787-2394 or [email protected].

FOR MORE INFORMATION:

View the agenda and follow the conference hashtag #counseling2025.

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Newswise — A new study examining the treatment of xylazine-associated wounds in Philadelphia sheds light on the severe medical complications and healthcare challenges caused by the widespread presence of the drug in the city’s illicit supply.

Conducted by surgeons at Cooper University Hospital and researchers from Drexel University College of Medicine and the Philadelphia College of Osteopathic Medicine, and overseen by the Rothman Institute Foundation for Opioid Research & Education, the study provides some of the first detailed insights into how hospitals are grappling with the influx of patients suffering from severe necrotic wounds linked to the veterinary sedative known as “tranq.”

Xylazine is a non-opioid veterinary tranquilizer that is increasingly being used as an adulterant in heroin and fentanyl. The drug can cause severe necrotic wounds that are difficult to treat, can compromise limb viability, and often require surgery.

The study reviewed the cases of 55 patients with self-reported xylazine use and upper-extremity wounds treated at a single Philadelphia-area hospital. Researchers found that 40% of these patients were homeless, 26% had psychiatric diagnoses, and 84% had a history of tobacco use. Hepatitis C was present in 67% of cases, and 5% were HIV-positive. Patients were frequently hospitalized for their wounds, with an average of nearly six admissions per person and some requiring dozens of hospital visits. One patient was readmitted 44 times.

“These wounds are very challenging to treat,” said Dr. Asif Ilyas, one of the study’s authors. “They are often very deep and involve tendons, bones, and other structures.”

Dr. Ilyas also noted that patients with xylazine-associated wounds often have underlying health conditions that make it difficult for them to heal properly. “Many of these patients are also struggling with addiction, which can make it difficult for them to follow through with treatment,” he said. Of the 55 patients, 60% received nonoperative wound care, while 22 underwent surgery. However, surgical intervention was complicated by continued drug use, with a 59% complication rate due to infections, graft failures, and other wound issues. Despite the severity of their injuries, nearly half of the patients left the hospital against medical advice, and 68% continued drug use during their hospital stay.

The study’s authors, led by Katharine Criner Woozley, MD, Chief of Hand and Nerve Surgery at Cooper University Hospital, recommend that surgeons take a multidisciplinary approach to treating patients with xylazine-associated wounds. This approach should involve working with addiction medicine specialists, social workers, and other healthcare professionals to address the underlying factors that contribute to the development of these wounds before intervening surgically.

“We need to do a better job of identifying and treating patients at risk for developing these wounds,” said Dr. Ilyas, President of the Rothman Institute Foundation for Opioid Research & Education and Professor of Orthopaedic Surgery at Drexel University College of Medicine. He also noted that the increasing prevalence of xylazine is a public health concern. “This is a growing problem that we need to address,” he said. “We need to educate the public about the dangers of xylazine, and we need to make sure that people who are struggling with addiction have access to the treatment they need.”

The study highlights the strain on Philadelphia’s healthcare system, with patients averaging 5.9 hospital admissions for xylazine-associated wounds, and the most extended hospital stay was 75 days, illustrating the demanding nature of this issue in the city.

“Philadelphia’s healthcare system is facing an enormous burden in treating these wounds, and the reality is that this is more than a surgical issue, says Dr. Ilyas. “We are seeing patients with severe infections and devastating wounds, but what makes treatment so difficult is the the interplay between the addiction, socioeconomic challenges, and the underlying mental health conditions.”

The study, The Management of Upper-Extremity Xylazine-Associated Wounds, was conducted by Parker Johnsen, MD; Aaron Jackson, MD; Sara Hope Buchner, MD, Pietro Gentile, MD, and Katharine Criner Woozley, MD, of Cooper University Hospital; Genoveffa R. Morway, DO, of Philadelphia College of Osteopathic Medicine; and Asif M. Ilyas, MD, of Drexel University College of Medicine and the Rothman Opioid Foundation.

The study will appear in The Journal of Hand Surgery and is found online at https://www.sciencedirect.com/science/article/abs/pii/S0363502324005987 The Journal of Hand Surgery is the Official Journal of the American Society for Surgery of the Hand (ASSH), publishes articles related to the diagnosis, treatment, and pathophysiology of diseases and conditions of the hand, wrist, and upper extremity.

About the Rothman Institute Foundation for Opioid Research and Education.

The Rothman Opioid Foundation, for short, is a non-profit 501c3 organization dedicated to raising awareness of the ongoing opioid crisis, educating physicians and patients on safe opioid prescribing and use – respectively, and advising policymakers on sound opioid and pain management policy. Most importantly, the Rothman Opioid Foundation performs and supports the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidenced-based pain management strategies while working to mitigate opioid abuse and addiction. https://www.rothmanopioid.org/

A new study from the University of Chicago Medicine reveals that people with alcohol use disorder (AUD) and depression experience high levels of stimulation and pleasure when intoxicated, similar to drinkers who do not have depression.

The findings counter the long-held belief that the pleasure people experience when drinking alcohol decreases with addiction and that drinking to intoxication is mainly to reduce negative feelings as a form of self-medication. 

“We have this folklore that people drink excessively when they’re feeling depressed and that it’s really about self-medicating,” said Andrea King, PhD, Professor of Psychiatry and Behavioral Neuroscience at UChicago and lead author of the study. “In this study of natural environment drinking and smart phone-based reports of the effects of alcohol in real-time, participants with AUD and a depressive disorder reported feeling acute, sustained positive and rewarding alcohol effects — just like their non-depressed counterparts.”

Published February 1 in the American Journal of Psychiatry, the research challenges conventional notions about alcohol’s effects in depressed people who drink excessively and could improve treatment approaches by focusing medication and behavioral approaches more on alcohol’s pleasure reward pathways and less on stress-responsive systems.  

“Currently, the focus of treatment is often on resolving stress and symptoms of depression, but that is only addressing one side of the coin if we don’t also address the heightened stimulation, liking and wanting more alcohol that occur in both depressed and non-depressed people with AUD,” said King, who has been conducting human research for decades to test responses to alcohol that lead to addiction.

The effects of alcohol on the brain are complex, and improved understanding of the factors that affect an individual’s vulnerability to AUD and depression is critical to identify and initiate early, effective treatment. However, few studies have examined how people with AUD respond to alcohol either in controlled laboratory settings or the natural environment; including individuals with AUD and another co-morbid diagnosis adds to the complexity.

The research followed 232 individuals across the U.S. between the ages of 21 to 35, corresponding to the period when most heavy drinking occurs in a person’s lifetime. Half of the study group met criteria for AUD in the past year and were evenly divided in terms of those who had or had not experienced a major depressive disorder in the past year. Individuals who had suicidal ideation were excluded for safety reasons, as were people who had severe alcohol withdrawal symptoms.

Through their smartphones, participants answered questions every half hour for three hours during one typical alcohol drinking episode and a non-alcohol episode. The researchers found that alcohol consumption reduced negative feelings, although the reduction was small and nonspecific to their depression or AUD status. The positive effects of alcohol were much higher in individuals with AUD than those without AUD and contrary to lore, similar in those with AUD and depression and those without depression. 

“For nearly a decade, our group has been improving methods to use mobile technologies to measure real time clinically meaningful outcomes in people with AUD and those at risk for alcohol-related problems,” said study co-author Daniel Fridberg, PhD, Associate Professor of Psychiatry and Behavioral Neuroscience at UChicago. “These approaches allow us to bridge the gap between the lab and real life and have led to new insights that could one day result in better treatments.”

The study’s findings call into question the predominant theory that alcohol addiction arises from the brain’s attempt to maintain stability despite repeated heavy drinking. That theory describes a “dark side of addiction” where repeated heavy drinking over time leads to changes in the brain systems involved in stress and reward. As a result of those changes, it is hypothesized that individuals shift from drinking for pleasure to drinking to avoid withdrawal and stress.

King says this theory does not account for the high levels of stimulation and pleasure that she likens to an accelerator pedal fueling more dependency.

“As treatment providers, we’re taught people with AUD are drinking to self-medicate and feel better,” said King. “But what exactly are they feeling? From our study, it seems to be high levels of stimulation and pleasurable effects, with a modest decrease in negative states.”

King’s next study examines whether adults between 40 to 65 years old who have had AUD for decades also experience similar heightened feelings of pleasure when drinking versus older drinkers without AUD. The prevailing theory would suggest these individuals would show blunted positive responses and high levels of tolerance to alcohol. King will examine whether they show a long-term sensitivity to alcohol’s enjoyable effects, much like in this study of depressed drinkers.

Newswise — WASHINGTON, DC — A new editorial in the BMJ suggests that a 22% decrease in overall U.S. drug overdose deaths over 2023/2024 signals that investments in overdose prevention and substance use disorder treatment are working. In Avoiding a new US “war on drugs”: Declining US drug overdose deaths show that evidence-based public health approaches work (Vincent Guilamo-Ramos, Adam Benzekri, Loftin Wilson, and Marissa D. Abram), the authors call for more investment in treatment and prevention to accelerate progress — and to reject calls for a return to “War on Drugs” tactics that bipartisan experts believe didn’t work.

“Evidence-based prevention and treatment are working in communities across the entire country. There’s also a growing sense across the ideological divide that this is the smartest approach, while the ‘War on Drugs’ simply wasn’t — because it was law enforcement-focused, disproportionately harmed communities of color, was a waste of money, and it just didn’t work. In an era of increased appetite for criminalizing health and social problems, we have already learned that addiction is best addressed with care, not convictions.  Bottom line: a return to ‘War on Drugs’ tactics could reverse the progress made in the overdose crisis and make the situation much worse,” said Dr. Vincent Guilamo-Ramos, IPS Executive Director and the Leona B. Carpenter Chair in Health Equity and Social Determinants of Health at Johns Hopkins School of Nursing. 

The editorial explores what is most likely driving the welcome decline in deaths – and why in some states overdoses are rising. It looks at how more “tough on crime” messaging could lead to a more law enforcement-driven response to drug taking and overdoses – pushing back progress, especially in communities of color where the decline has been slower. It explores existing prevention and treatment successes – such as major changes in opioid medication prescription policies and practices, expanded access to opioid use disorder medications, and the scaling-up of community-based harm reduction services. Finally, it notes promising new strategies to further eliminate substance related prevention and treatment inequities such as: community and family-based models of prevention and treatment service delivery in marginalised communities and achieving a health workforce more representative of the populations served.

“Making the right call at this moment-of-opportunity is key to save and improve more lives. The wrong call is for approaches that are ineffective and unjust; this would fail all US communities — especially those in which overdose deaths continue to rise. It’s time to get tougher FOR prevention and treatment, for MORE targeted investment in prevention and treatment – and not to repeat the mistakes of the past,” Guilamo-Ramos stressed. 

ENDS

Notes to editors

A: Overdose Death Rate per 100,000 (age-adjusted)

B: Number of Overdose Deaths

More on IPS

The Institute for Policy Solutions (IPS) at Johns Hopkins School of Nursing ends health inequities through evidence-based policy solutions. IPS is focused on nurse-driven solutions to solve one of the country’s most alarming and unsustainable problems: health inequities. Nurses bring novel solutions to health system reform that optimize health for all — no matter who you are or where you live. Our expertise and insight into the systems that deliver care and impact health, as well as what matters to patients, families, and communities, uniquely position the nursing profession to transform health care delivery to prioritize health and well-being. Through nurse leadership, the Institute drives collaborations with interdisciplinary and cross-sectoral partners in dialogue, discovery, and the adoption of solutions for making optimal health attainable for all. Details at ipsnow.org

BYLINE: Steven Infanti

The Appalachian region continues to experience disproportionately higher opioid overdose rates and related fatalities. According to the most recent Center for Disease Control and Prevention, fully one-half of the 16 states with the highest overdose death rates are Appalachian states. West Virginia tops the list, and is joined by, in descending order, Tennessee, Kentucky, Ohio, South Carolina, North Carolina, Pennsylvania, and Maryland. And although the CDC’s data shows a 4% overall overdose death rate decline, the statistics for Appalachia remain stubbornly high.

A Philadelphia-based non-profit foundation is combating the opioid addiction epidemic at the source by educating frontline allied health professionals on various aspects of the nation’s opioid crisis, specifically in Pennsylvania and the Appalachian region.

The Rothman Orthopaedic Institute Foundation for Opioid Research and Education (aka, Rothman Opioid Foundation) is a leader in opioid-related research and education. Thanks to a three-year grant from the federal Appalachian Regional Commission and support from the Pennsylvania General Assembly, the Foundation has used its expertise to educate allied health professionals in Pennsylvania and the broader Appalachian region on proper opioid prescribing and use.

Rothman Opioid Foundation has created and distributes opioid education curricula at no cost for the 75 allied healthcare professional training programs, such as nurse practitioners and physician assistants, at collegiate institutions across the Appalachian Region. In particular, the Foundation has produced an 8-module online pain management curriculum designed to complement any training program focusing on evidence-based pain management using opioid-sparing strategies.

“Physician assistants and nurse practitioners are valued professionals and are often on the front line of primary care and pain management, and they will greatly benefit from formal training in opioid pharmacology, use, abuse, and safe evidenced-based pain management strategies,” says Dr. Asif Ilyas, MD, MBA, FACS, President of the Rothman Opioid Foundation in Philadelphia, PA. The Foundation has developed its curriculum as a prescriber-training program and is offering this eight-hour course free of charge. It is an online, self-paced certificate program designed to effortlessly complement students’ current curriculum in the clinical phases of their training and prescribers in practice. The targeted allied health professionals include nurse practitioners (NPs) and physicians’ assistants (PAs). The curriculum’s training includes, but not be limited to, opioid prescribing guidelines and indications, pain management alternatives to opioids, identification of potential opioid abuse, and intervention strategies. Additional educational programs will include online webinar series and in-person events when feasible. The curriculum is designed to complement the clinical phase of NP and PA training programs but can be implemented at any stage in training. While designed specifically for NP and PA students, the Rothman Opioid Foundation submitted the course material to a rigorous national accreditation process. As a result, the curriculum has been accredited for up to 13.5 Continuing Medical Education (CME) credit hours. It satisfies the Federal Drug Enforcement Agency Medication Assisted Treatment Education (DEA MATE) Act 8-hour training requirement on the treatment and management of patients with opioid or other substance use disorders. That means any licensed prescriber, physician, NP, or PA can obtain the required CME or DEA MATE opioid training through this vital course material. While most opioid-related education currently targets physicians, Ilyas says, NPs and PAs often interact more with individuals who are suffering from or are susceptible to opioid misuse.

“NPs and PAs have prescribing rights. They are vital physician extenders who need to be educated and recruited in the fight against the opioid addiction crisis across the Appalachian region,” says Ilyas. “This information will be tailored specifically to these allied health professionals to mitigate the rate of opioid addiction at the source by teaching proper opioid use and early symptoms of misuse to decrease the risk of opioid dependency and abuse. “The Rothman Opioid Foundation plans to partner with colleges and universities to distribute this information to as many healthcare students as possible in the Appalachian Region. This project’s ultimate goals are to ensure that PAs and NPs have the proper resources and education to advise on proper opioid use and its alternatives, recognize the initial symptoms of opioid misuse and abuse, and understand when and how to intervene when substance abuse occurs.“The opioid addiction crisis has taken a drastic toll on the Appalachian region and the country. To lower the chance of misuse and overdose in patients, it is imperative that our local frontline healthcare workers are adequately trained and educated in the pathophysiology of opioid addiction, and they have resources available to guide effective and safe pain management,” says Ilyas.

According to the Centers for Disease Control and Prevention (CDC), 130 Americans die every day from opioid overdose. This includes prescription and illicit opioids. Low-income and rural areas are among the most likely to experience the opioid addiction crisis’s adverse effects, as evidenced by data published by the Appalachian Regional Commission. Rural residents are at greater risk in part due to a lack of resources or healthcare  services to address their addiction. These regions often lack accessible health services, especially those considered “specialized” services, such as addiction treatment.In addition, communities with a high uninsured population are at greater addiction risk as individuals without healthcare insurance are much less likely to receive treatment than those who are insured. These individuals are more likely to seek primary care through an urgent care setting, generally staffed by a physician extender (PAs and NPs).

As noted above, these allied health professionals have not always received the opioid-related education that their physician counterparts have.“Therefore, it is essential that professional education, designed to provide allied health professionals with the tools necessary to both manage pain in an evidenced-based opioid-sparing manner as well as screen for and identify addiction in the primary care setting visit, is available across Appalachia’s rural regions,” says Ilyas. Rothman Opioid Foundation is committed to providing the educational tools needed by our allied health professionals across the Appalachian region as they serve and treat on the front line of the opioid crisis. Information on the curriculum is found here: https://www.rothmanopioid.org/opioids-pain-management

About the Rothman Orthopaedic Institute Foundation for Opioid Research and Education.

The Rothman Orthopaedic Institute Foundation for Opioid Research & Education, www.rothmanopioid.org , is a non-profit 501c3 organization dedicated to raising awareness of the risks and benefits of opioids, educating physicians/physicians/policymakers on safe opioid use, and supporting research and education aimed to advance innovate pain management strategies that can decrease opioid use. The Foundation supports and advances the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidenced-based pain management strategies.