Category: From Newswise – Addiction

Newswise — HOUSTON ― The University of Texas MD Anderson Cancer Center’s Research Highlights showcases the latest breakthroughs in cancer care, research and prevention. These advances are made possible through seamless collaboration between MD Anderson’s world-leading clinicians and scientists, bringing discoveries from the lab to the clinic and back. 

Smoking cessation medications are safe and effective for people with depression
Individuals with major depressive disorder (MDD) are more likely to smoke, leading to higher risks of nicotine addiction and early death from tobacco-related illnesses. To identify the best treatments for quitting, researchers led by George Kypriotakis, Ph.D., and Paul Cinciripini, Ph.D., evaluated the safety and efficacy of three smoking cessation monotherapies previously approved by the Food and Drug Administration – varenicline, bupropion and nicotine patches – on 6,553 participants with current or past MDD. There were no differences in risk of neuro-psychiatric adverse events based on medication among all participants. According to the study, varenicline plus counseling had greater efficacy – continuous abstinence during the nine to 12-week period – and may be the best treatment for individuals with past or current MDD. Participants with current MDD also had reduced anxiety and depression while trying to quit. The study highlights the safety and efficacy of these medications for MDD and emphasizes the continued need for more research to address both untreated depression and nicotine addiction to improve outcomes. Learn more in The American Journal of Psychiatry.

Definitive radiotherapy demonstrates effectiveness in metastatic thyroid cancers
Definitive radiotherapy (dRT), intended for long-term disease control, is an effective option for several solid tumors that are oligometastatic, meaning they have limited metastatic lesions, or oligoprogressive, meaning few metastases are progressing. However, the benefit of dRT for metastatic thyroid cancers is largely unknown. Researchers led by Matthew Ning, M.D., examined the use of targeted dRT using stereotactic body radiotherapy (SBRT) in 119 patients with oligometastatic/oligoprogressive thyroid cancer. Treatment with dRT showed a 91% local control rate for treated sites at three years and was associated with significant delays in the need for systemic therapy, the current standard of care. Only 2.5% of patients experienced grade 3 toxicities, with no higher-grade events. The median time to systemic therapy escalation, which can bring significant adverse effects and impact quality of life, was more than four years. While further studies are needed, this study highlights the potential of dRT in controlling oligometastatic and oligoprogressive thyroid cancers. Learn more in the Journal of the National Comprehensive Cancer Network.  

Targeting signaling pathway may overcome treatment resistance in pancreatic cancer
Many patients with late-stage pancreatic cancer develop resistance to various treatments including first-line chemotherapy, highlighting a need to identify and understand the mechanisms of resistance. To provide insights, researchers led by Yohei Saito, Ph.D., Yi Xiao, Ph.D., and Dihua Yu, M.D., Ph.D., examined single-cell transcriptomic data from models of pancreatic cancer and clinical pathological information from patients with pancreatic cancer. They discovered a novel signaling circuit – Yap1 in cancer cells and Cox2 in fibroblasts of tumor microenvironment – that is activated during chemotherapy and helps these cancer cells survive. Co-targeting Yap1 in cancer cells and Cox2 in fibroblasts effectively overcame chemotherapy resistance and significantly extended survival in preclinical models. Interestingly, clinical analyses revealed that patients with pancreatic cancer who received statins, which inhibit Yap1, and aspirin, which targets Cox2, had prolonged survival during chemotherapy. These findings further highlight the therapeutic potential of co-targeting this signaling circuit to overcome resistance and improve patient outcomes. Learn more in Cell Discovery. 

ctDNA in appendix cancer reveals new insights for prognosis and treatment 
Appendiceal adenocarcinoma (AA), a rare type of appendix cancer, can be challenging to detect. While it is often treated with surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), better tools are needed to guide patient selection, monitoring and treatment decisions. Researchers led by Michael White, M.D., and John Paul Shen, M.D., analyzed circulating tumor DNA (ctDNA) in AA and identified a unique mutational profile, with TP53 mutations being the most common. They detected ctDNA less frequently in metastatic AA and at lower levels than in colorectal cancer, suggesting that AA sheds less DNA into the bloodstream. Detectable ctDNA was associated with lower survival rates, highlighting ctDNA’s potential as a valuable tool for identifying AA patients with poorer prognoses. This approach could enhance patient selection and monitoring in AA care. Learn more in Clinical Cancer Research.  

TP53 aberrations affect treatment response and survival in myeloid leukemias
TP53 genetic alterations are associated with poor outcomes in myeloid leukemias, but their exact impact on treatment response and survival, considering newer treatment options and allogeneic hematopoietic stem cell transplantation (HSCT), warrants further evaluation. In a new retrospective study, researchers led by Jayastu Senapati, M.D., D.M., Sanam Loghavi, M.D., and Naval Daver, M.D., analyzed 413 newly diagnosed patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) with TP53 mutations. They characterized the relationship between patient outcomes and multiple variables, such as age, disease state, TP53 mutation burden, and therapy received. The study found improved survival outcomes in those with AML and a low-risk TP53 aberration and all patients treated with an HSCT. The overall response rate was 62% and 53% in patients with MDS and AML, respectively. Patients with AML also had higher overall response rates and composite complete response rates when treated with venetoclax, although this did not translate to higher rates of allogeneic HSCT or survival. The comprehensive analysis highlights the importance of knowing a patient’s burden of TP53 aberrations to predict outcomes and determine better therapeutic strategies. Learn more in Haematologica. 

Awards and Honors

MD Anderson at ASH 2024
Read below for highlights from MD Anderson researchers at the 66th American Society of Hematology (ASH) Annual Meeting and Exposition. More information can be found at MDAnderson.org/ASH.

In case you missed it
Read below to catch up on recent MD Anderson press releases.

Read this press release in the MD Anderson Newsroom.

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Newswise — Program Manager Alejandra Cortez, LCSW, recognizes that working with high school students is as much about learning as it is about teaching. “When we are working with youth, I see amazing growth both in the students and in my own team,” Cortez explains.

Youth Advocate Dayanara Fonseca agrees. “We have worked with one student since her freshman year,” Fonseca says. “At first, she was really shy. But after a while, she started to become more outgoing, and now she has volunteered for so many outreach events and has spoken publicly about how the program has impacted her.”

Cortez and Fonseca work in the Substance Use Prevention and Treatment Program within Adolescent and Young Adult Medicine at Children’s Hospital Los Angeles. For the past five years, Cortez has led what was formerly known as Youth Partnerships for Success and is now called the Student Leaders Advocating for Youth (SLAY) Program. Cortez’s team works with a student leadership group called Youth in Power at two different Alliance charter schools in Northeast Los Angeles to provide substance use and overdose prevention training, as well as mentorship, mental health resources, and career preparation education, to dozens of high school students each year. The program recently received a $2 million grant from the U.S. government’s Substance Abuse and Mental Health Services Administration (SAMHSA) to continue carrying out its work.

 

The SLAY Program involves about 15 to 20 students at Alliance Tennenbaum Family Technology High School each year, and around the same number of students at Alliance Leichtman-Levine Family Foundation Environmental Science High School. “Both schools are in the same area close to Highland Park, but many of the students commute from all over,” Cortez explains. “I’m actually from that neighborhood myself, and that combined with the fact that I previously interned at CHLA while obtaining my Master of Social Work degree is why I was recruited to CHLA.”

Identifying areas of community need

The SLAY Program started out as the Youth Partnerships for Success program in the Fall of 2019, when Cortez’s team applied for and received their first SAMHSA grant supporting the program’s activities. “Our team, which consists of myself, a health educator, and Dayanara, who is a near peer-age youth advocate also from Northeast L.A., would meet with youth at these two schools once a week [and remotely during the COVID-19 pandemic] to determine specific topics on which we would focus our work,” Cortez says.

Selected topics included reducing cannabis and alcohol use, promoting positive mental health and self-care practices, and building resumes. While Fonseca would help to interpret the students’ ideas and concerns, the health educator would offer training sessions to educate students in these areas so that they could then present helpful information to their peers.

“And then once every year, we have a big summit on each school campus that is open to all youth, parents, and community members,” Cortez explains. “The SLAY Program students lead educational panels to inform their classmates on the issues we’ve been studying and to make a positive impact in their community.”

Other program activities have included the creation of a peer-focused zine on substance-use prevention strategies, as well as a community pet drive. “Our program was also involved during Red Ribbon Week at the schools,” Fonseca explains, referring to the largest drug-abuse prevention campaign in the country. “Our students handed out printed resources with information on substance use prevention and hosted activities for their fellow students.”

Sharing accomplishments and looking ahead

As the initial grant funding period neared its end, Cortez’s team applied for a new SAMHSA grant. They also presented their program’s achievements at the SAMHSA national conference in Washington, D.C.

In August 2024, they were awarded a new $2 million grant. “We’re hoping that with this new grant, we’ll be able to expand on the work that our past students accomplished,” Cortez says. “Our vision is for our students to have the tools and resources needed to become experts who can lead structural change on their campuses.”

One of the SLAY Program’s new goals is to create a resource guide that directs students to therapists and community-based support agencies. Cortez also wants to place more emphasis on addressing mental health challenges and how these issues intersect with substance use. “We want to take a harm reduction approach to our sessions, focusing on what particular substances do to your body and how people who are already using these substances can access resources to reduce their dependence on them,” she explains.

 

This work will also involve education on the use of naloxone, a medicine that can quickly reverse an opioid overdose. “We’re working with the schools to get youth trained to administer naloxone and to have more open conversations about opioid use prevention,” Cortez says. “In the large Latino community in Northeast L.A., many people might not be open to talking about these issues, but we want to change that.”

Fonseca also appreciates the work of the program to open new conversations in Northeast L.A. “Witnessing people in my community who are passionate about substance use prevention is something that I hadn’t seen before,” she says. “It’s really fulfilling to see that youth today are actively working with their schools and with us to enact change.”

The SLAY Program also works collaboratively with another student group led through CHLA, the Collective of Youth Leaders. This group is primarily focused on naloxone training and opioid overdose prevention and advocacy in several areas throughout Los Angeles.

Cortez looks to the future of the SLAY Program with excitement. “It’s such a privilege to get to work in the community where I grew up,” she says. “Our hope is to continue highlighting the value that young folks bring to the table and ensuring that their schools and communities listen to them, which can lead to enormously positive changes.”

 

Newswise — The thought of illegal drug sales evokes images of deals done on shady street corners. But a new study from Case Western Reserve University exposes a critical but underreported element of the illegal drug market: so-called “peer-brokered” sales.

Peer-brokered sales, in which people buy drugs for others within their social circles and take a cut—either as a share of the drugs or money by inflating the price—play a widespread and vital role in the distribution of illegal substances, according to the new study.

The research, recently published in the journal Contemporary Drug Problems, was based on a survey of 241 active drug users in Ohio. Instead of buying drugs directly from dealers, many users rely on friends or peers—often referred to as brokers—to buy drugs for them.

The study found that 71% of respondents had brokered a drug transaction in the past month, and 90% had done so at some point. On average, brokers bought drugs from four different sellers and acted as intermediaries for seven buyers.

The findings challenge the conventional view of drug markets as isolated transactions, highlighting the importance of social networks in facilitating access to illegal substances, said Lee Hoffer, associate professor of anthropology at Case Western Reserve University’s College of Arts and Sciences and the study’s co-author.

“Brokering reshapes the way we think about drug markets,” said Hoffer, who was joined in the research by Allison Schlosser, assistant professor of anthropology at the University of Nebraska Omaha. “Instead of isolated sellers and buyers, we see interconnected networks of people exchanging drugs in a way that can drive demand and expand access.”

The study also examined the motivation of brokering, with 84% of brokers using drugs themselves. Nearly half admitted to inflating prices or skimming a portion of the drugs. For many brokers, these exchanges allow them to obtain drugs for free, further complicating traditional approaches to drug-market regulation.

The consequence of peer-brokered sales, Hoffer said, is that it challenges conventional approaches to attacking the illegal drug trade.

“Attempts at supply-and-demand reduction, such as law-enforcement crackdowns, have not proven effective,” he said. “We need new strategies that focus on understanding and addressing the social networks that drive the market.”

The study, which also includes input from syringe-service programs in Ohio, identifies the need for a more comprehensive approach to drug-market intervention—one that incorporates the role of peer brokers.

Hoffer said that, as new drugs emerge and drug-use patterns shift, understanding these networks will be crucial for policymakers hoping to disrupt drug-trafficking.

“If we want more effective public-health strategies, we need to gain a more robust idea of how drug-brokering plays a role,” Hoffer said.

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For more information, contact Colin McEwen at [email protected].

Newswise — Dr. Deborah Padgett, a renowned researcher from New York University, is leading the charge in rethinking the U.S. approach to homelessness. In her groundbreaking research, Dr. Padgett delves into the complex issues facing individuals experiencing homelessness, from mental health challenges to substance addiction. While the debate surrounding homelessness often becomes mired in stigma and politics, Dr. Padgett is determined to separate fact from assumption and find effective solutions based on solid evidence.

Through her studies, Dr. Padgett focuses on practical, evidence-backed approaches to combat homelessness. One key area of her research is examining the impact of housing vouchers and assistance programs in stabilizing lives. Her team works to quantify the effectiveness of these initiatives, providing data that proves housing-first solutions are not just theoretical but highly actionable. Dr. Padgett’s work is pivotal in demonstrating that there is, indeed, a solution to homelessness—and it is not only possible but achievable with the right policies and support systems in place.

The latest episode of the Curious by Nature podcast, titled “There Is a Solution to Homelessness and It’s Doable” featuring Dr. Deborah Padgett is now available on Spotify and Apple Podcast.

Curious by Nature, presented by Newswise, is a podcast for curious people. In each episode, listeners can travel briefly into the fascinating world that comes with years of dedication to one field of study. Be inspired by the many amazing things that are going on right now, some of which may have a major effect on our lives. Enjoy this concentrated knowledge from experts. We hope you can take inspiration from glimpses of innovation, dedication, and discovery.

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Spotify Podcast: https://bit.ly/3ZJ78pO
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COLUMBUS, Ohio – Alcohol’s ability to increase people’s pain threshold is one reason that drinking also leads to more aggressive behavior, a new study suggests.

Researchers found that the less pain that study participants felt after drinking an alcoholic beverage, the more pain they were willing to inflict on someone else.

“We’ve all heard the idiom ‘I feel your pain,’” said study co-author Brad Bushman, professor of communication at The Ohio State University.

“But if intoxicated people can’t feel their own pain, they might be less likely to feel empathy when others feel pain, and that could lead them to be more aggressive.”

The study was published recently in the Journal of Studies on Alcohol and Drugs.

This study used an experimental design that has been used in research studies since 1967 and has been approved for use in humans in this study and others.

This new research involved two independent laboratory experiments, one with 543 participants and the other with 327 participants, all of whom reported consuming 3-4 alcoholic beverages per occasion at least once a month. They were recruited by newspaper advertisements and paid $75. The methods for the two experiments were identical.

After giving informed consent, participants were given 20 minutes to drink an alcohol or placebo beverage. The orange juice beverages looked identical so participants wouldn’t know which one they got.  For the placebo drinks, the researchers put a small amount of alcohol on the top of the orange juice and sprayed the rim of the glass with alcohol so that it tasted like an alcoholic beverage.

After drinking the beverage, each participant received one-second electrical shocks to two fingers on one hand. The researchers increased shocks in intensity until the participant described the shock as “painful.” That was labeled the participant’s pain threshold.

They then participated in an online competitive reaction time task in which the winner could deliver a shock to the loser. The shocks ranged from 1 (low) to 10, which was the level the participant rated as “painful.”  Participants could also choose how long the shocks lasted.

In reality, there was no opponent and the researchers randomly declared the participant the “winner” in half of the reaction time tasks. The purpose was simply to see if those who drank the alcoholic beverage would be willing to deliver stronger and longer shocks – and whether a higher pain threshold had an impact.

Results showed that for those drinking alcohol, the alcohol increased the level at which the shocks became painful to them. And the greater their tolerance for physical pain, the greater their level of aggression in terms of the intensity and length of shocks they were willing to deliver to the opponent.

Those who drank the placebo drinks weren’t as aggressive in their response, partly because their pain threshold was generally lower than those drinking alcohol, Bushman said.

“In other words, they were still able to feel their own pain – and didn’t want to inflict pain on others,” he said.

“There are many reasons that intoxicated people are more likely to intentionally hurt others, but this research suggests pain tolerance is one possible reason.”

Bushman noted that the people who drank alcohol in this study had blood alcohol concentrations averaging between 0.095% and 0.11%.  That’s slightly above the legal limit in most states, which is 0.08%.

“The effects of alcohol on pain tolerance may be higher for those who drink more than what they did in these experiments,” Bushman said. “That may make them even more willing to be aggressive against others.”

Co-authors on the study were C. Nathan DeWall of the University of Kentucky, and Peter Giancola, a licensed clinical psychologist in Montreal.

The research was supported by the National Institute on Alcohol Abuse and Alcoholism and the National Center for Research Resources.

Rutgers startup Zena Therapeutics strives to create narcotic medications that will minimize or even eliminate overdoses from prescription drugs.

Co-founded by Eileen Carry, PhD, and Ariane Vasilatis, PhD, the company is based on an innovation developed at Rutgers, The State University of New Jersey: a novel compound that does not increase the risk of overdose if taken with other central nervous system depressing substances such as opioids and alcohol.

“What we want to do is design medication so that even if it is misused, death is not the consequence,” said Carry. “Right now, when it comes to narcotics drugs, the onus is on the patient to take the medication as prescribed, but that is not a guarantee. We hope to shift the paradigm to substantially reduce overdose risk without compromising efficacy.”

“We believe that it is feasible and possible to design drugs and medications where death is not the end result of misuse, whether it’s accidental or on purpose as recreationally,” said Vasilatis. “We both have had family and friends succumbing to addiction and overdose, unfortunately, so we share a passion for this self-started project.”

The partnership between Carry and Vasilatis began at the lab of James Simon, PhD, a Distinguished Professor in the Department of Plant Biology at Rutgers School of Environmental and Biological Sciences. Carry’s research was focusing on safer medications for addiction and mental health, which led her to develop a proprietary compositional molecule. She asked Vasilatis to join her in entrepreneurial training with the I-Corps program at Rutgers, and from there, Zena Therapeutics was formed.

Said Vasilatis, “The I-Corps training, both at Rutgers and the national program, was paramount for us because we needed to understand: is there an end user? Is there a market for this? Or is it so niche that it would never get to that end user? I-Corps helped us realize that we had a little bit more of a niche market, but there was a broader application. Programs like I-Corps or the Yale Innovation Impact have been invaluable with all the knowledge we’ve gained and the people we’ve met through them.”

“We were able to hone our business model through participation in two National Science Foundation (NSF) I-Corps programs, the regional here at Rutgers and the national,” said Carry. “Doing the I-Corps training, where we interviewed prescribers and people from the patient demographic, we realized what a huge issue this is and that there’s a gap; nobody’s really focusing on this issue. So that motivated us to keep moving forward.”

According to the National Institute on Drug Abuse, drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to over 17,000 in 2017, and has hovered around 15,000 per year since. Carry and Vasilatis believe that people with addictive tendencies may become hooked on their prescription medication, and because over 40% of U.S. adults drink alcohol while using medications, their innovation could be life-changing to many people and families.

The company’s website states that early studies with its novel compound show “favorable pharmacokinetics, robust anxiolytic activity…and favorable safety characteristics.” Carry and Vasilatis hope the compound will help both individuals suffering from general anxiety and panic disorders as well as those dealing with withdrawal symptoms.

“We’re starting with anxiety medications, specifically hoping to create alternatives for benzodiazepines, which are the current standard treatment for general anxiety and panic disorder and are commonly involved in overdoses with opiates,” said Carry. “Previously, companies have focused on the addictive potential of drugs. We understand that any psychoactive medication has addictive potential in the sense that it also has a mental component. However, none of the current medications were optimized to reduce overdose risk, and we believe we can do that without compromising efficacy. Essentially, we are creating medication with a ceiling effect, so if somebody takes the whole bottle, it won’t raise past the level of mild sedation but will still help with the anxiety.”

Vasilatis and Carry will continue to work together to lead Zena Therapeutics, which is named after the Slavic word for ‘woman’ (žena), serving as Chief Executive Officer and Chief Scientific Officer, respectively. The company has so far received funding through the New Jersey Health Foundation, the I-Corps program, $1 million in seed funding from Foundation Venture Capital Group, LLC, and a Phase I National Institutes of Health STTR (Small Business Technology Transfer) grant, the latter through which they are able to use Rutgers core services. The next step, according to Carry, is to move the compounds to clinical trials.

“It seems like whoever jumps onto the Zena Therapeutics bandwagon doesn’t leave,” laughed Vasilatis. “And everyone who has helped us has been invaluable, from Dr. Simon, who helped push us into the I-Corps program, to Dr. Nicholas Bello (at the Department of Animal Sciences) who helped us obtain our Phase I STTR, to Dr. Jacques Roberge at the Rutgers Biomolecular Innovation Cores, to Rutgers Office for Research’s Technology Transfer and New Ventures teams, who have been keeping tabs on us and sending us grant opportunities or anything they feel that can help us. Our passion is what created Zena, and Eileen’s ideas are what created the foundation for the company, but we wouldn’t have been able to move forward without this support.”

“Zena Therapeutics is another example of how Rutgers researchers focus their work on issues and questions facing the world,” said Deborah Perez Fernandez, PhD, MBA, executive director of Technology Transfer, and Vince Smeraglia, JD, executive director of New Ventures. “The opiate crisis is personal to both Drs. Carry and Vasilatis, as it is to so many people, and the Technology Transfer and New Ventures teams are proud to support them in their endeavors to solve this issue.”

Alcohol use was the most common predictor of escalating cannabis vaping among youth and young adults, independent of demographic factors, according to research by UTHealth Houston published this month in the journal Social Science & Medicine. 

Cannabis vaping is the use of electronic cigarette delivery of liquid tetrahydrocannabinol (THC), a concentrated form of cannabis that has been extracted and diluted into a liquid solution.Vaping cannabis has grown in popularity among young people in the U.S., according to the Substance Abuse and Mental Health Services Administration

“A decade ago, 10% of cannabis users vaped it. Now, the number is about 75%, at least for youth and young adults,” said Dale Mantey, PhD, assistant professor of health promotion and behavioral sciences at UTHealth Houston School of Public Health. “That is a major public health concern for many reasons.”

Cannabis vaping in youth and early adulthood can affect cognitive development and performance, including learning, memory, and attention; lead to the onset of chronic pulmonary damage from black market liquid THC products, as well as an increase in dependence on the drug; and result in incarceration due to federal prohibitions, which list cannabis as a Schedule I drug.

In this study, researchers focused on identifying the predictors of behavior of cannabis users and nonusers. The data included middle to high school students in Dallas/Fort Worth, San Antonio, Austin, and Houston. The students were surveyed from 2019 to 2021 and asked two questions: “Have you ever smoked marijuana or liquid THC from an electronic cigarette?” And “During the past 30 days, how many days did you smoke marijuana from an electronic cigarette?” The students were also asked to self-report their racial and ethnic identity, gender, nicotine usage, and alcohol consumption. Researchers also investigated two indicators of mental health among the student population: anxiety and depression.

“If we know what predicts that behavior, those are the things we can try to target for addressing and preventing cannabis vaping among youth,” Mantey said.

At the beginning of the study , 72.7% reported never cannabis vaping, 12.7% reported ever cannabis vaping, and 14.5% reported current cannabis vaping. Through the three-year duration of the study, the risk for cannabis vaping experimentation (never to current) was significantly higher among non-Hispanic Blacks relative to non-Hispanic whites and non-Hispanic other groups. 

Alcohol proved to be a consistent factor in those who had never vaped cannabis to begin or experiment. Researchers referred to alcohol as a “gateway” to cannabis vaping, “The ultimate goal is to delay initiation of substances in youth because the later someone initiates a substance, the less likely they are to become addicted to it,” Mantey said. “Since alcohol was shown to be a strong predictor, we need more comprehensive interventions. When we go into schools and talk about nicotine, vaping, or tobacco prevention, we need to make sure we are incorporating cannabis prevention and alcohol prevention, not just one substance.”

Depression predicted cannabis vaping initiation among Hispanics and non-Hispanic Blacks groups. The authors said more research is needed to understand the impact depression and other mental health problems may have on cannabis vaping among various demographics so public health intervention can target the most at-risk groups.

Additional UTHealth Houston authors included Stephanie L. Clendennen, DrPH, MPH; Baojiang Chen, PhD; Sana Amin, MPH; and Melissa B. Harrell, PhD, MPH.

Media inquiries: 713-500-3030

BYLINE: Dr. Asif Ilyas

The emergence of xylazine in the illicit drug supply marks a new chapter in the ongoing overdose crisis. This veterinary tranquilizer, often mixed with fentanyl, poses significant risks to public health and challenges our existing strategies for combating drug abuse and overdose deaths.

Xylazine, known on the streets as “tranq,” has rapidly spread across the United States. The Drug Enforcement Administration reports that xylazine and fentanyl mixtures have been seized in 48 out of 50 states. In 2022, approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine. This widespread presence indicates a growing threat that demands immediate attention.

The dangers of xylazine are multifaceted. When combined with opioids like fentanyl, it increases the risk of fatal overdose. Xylazine can cause dangerous decreases in breathing, heart rate, and blood pressure. Unlike opioid overdoses, xylazine-related overdoses do not respond to naloxone, the standard overdose reversal medication. This complicates emergency response efforts and puts additional strain on our healthcare system.

Moreover, repeated xylazine use is associated with severe skin wounds, including open sores and abscesses. These wounds can lead to tissue death and, in extreme cases, require amputation. The medical community is still grappling with how to treat these xylazine-related injuries effectively.

As we confront this new crisis, we must learn from our experiences with the opioid epidemic. The rapid spread of xylazine mirrors the trajectory of fentanyl, which began in white powder heroin markets in the Northeast before expanding nationwide. This pattern suggests that xylazine use will likely increase and become more prevalent in the illicit drug supply.

To address this emerging threat, we need a comprehensive, multi-faceted approach. This includes increased awareness, expanded testing capabilities, and the development of targeted treatment strategies. Healthcare providers, first responders, and harm reduction organizations need to be educated about xylazine and its effects to provide appropriate care and interventions.

Research is crucial in understanding xylazine’s impact on the body, its role in the overdose crisis, and potential treatment options. The National Institute on Drug Abuse is supporting studies to explore these areas, but more resources and attention are needed.

Policymakers must also consider the regulatory landscape surrounding xylazine. While it is not currently a controlled substance under federal law, some states have begun to place it on their controlled substances lists. In Pennsylvania, Governor Josh Shapiro signed into law Act 17 of 2024, bipartisan legislation to permanently list Xylazine as a controlled substance.  A balanced approach that restricts illicit use while maintaining legitimate veterinary access is necessary.

It’s one of the reasons we are organizing the symposium “The Next Chapter of the Opioid Epidemic in Pennsylvania: The Xylazine Crisis” and making it free for medical professionals and students. By bringing together state government policymakers, physicians, and surgeons, this event will foster crucial discussions on the current state of the crisis and evidence-based treatment strategies.

As we face this new challenge, collaboration between government agencies, healthcare providers, researchers, and community organizations is essential. We must act swiftly and decisively to prevent xylazine from exacerbating the already devastating impact of the opioid crisis. By learning from past experiences and adapting our approaches, we can work towards mitigating the harm caused by xylazine and protecting public health.

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Dr. Asif Ilyas is President of the Rothman Opioid Foundation in Philadelphia, a Professor of Orthopaedic Surgery at Thomas Jefferson University, and an Associate Dean of Clinical Research at the Drexel University College of Medicine.

Study Identifies Pregnant Women at Risk for Substance Use

STONY BROOK, NY, November 18, 2024 – Use of tobacco, alcohol, cannabis, and illicit drugs is dangerous in pregnancy, increasing risks of stroke, miscarriage, preterm delivery, low birth weight and infant neurodevelopmental problems. Yet according to the 2020 National Survey of Drug Use and Health, more than 20 percent of pregnant women in the United States report using one or more of these substances. Public health experts agree on the need to identify pregnant women who are most vulnerable to using harmful substances. A new study published in the Journal of Addiction Medicine conducted by a team of Stony Brook University researchers used the PROMOTE Prenatal Screener – a unique screening tool for use during pregnancy – to pinpoint vulnerabilities for substance use.

The study, led by Heidi Preis, MSW, PhD, Assistant Professor of Research in the Department of Obstetrics, Gynecology and Reproductive Medicine in the Renaissance School of Medicine (RSOM), focused on vulnerabilities for tobacco, cannabis, or alcohol use in pregnancy.

“When patients complete the PROMOTE at the start of their prenatal care, their health care providers can identify any psychological, social, or other needs and determine whether a particular patient is likely to use harmful substances during pregnancy,” explains Preis, who also has academic affiliations and collaborates with Stony Brook’s Program in Public Health and Department of Psychology. “This way a patient’s needs can be addressed very early and she can be referred for counseling, treatment, or resources, and this reduces harms for both mother and child.”

Preis and colleagues developed the PROMOTE with a grant from the National Institutes of Health’s National Institute on Drug Abuse (NIDA). Prior to its creation, a comprehensive yet concise screening tool to detect psychosocial and substance use risk was not available in prenatal care settings. The PROMOTE includes 18 core items that address vulnerabilities in areas such as education, financial stability, living conditions, partner and family stress and support, exposure to violence, and mental health.

For their current study, the team reviewed medical charts of 1,842 patients who completed the PROMOTE during their first prenatal visit to a New York State health system outpatient clinic.  They found that 188 patients (10.2%) used at least one substance during pregnancy, including 132 (7.2%) tobacco, 50 (2.7%) cannabis, and 45 (2.4%) alcohol. Patients with limited education were most likely to use tobacco during pregnancy, single and unpartnered patients were most likely to use cannabis, and those who experienced a major stressful life event were most likely to use alcohol during pregnancy. Other vulnerabilities were also associated with harmful substance use.

Their study results highlight the value of using a well-developed screening tool to gain a better understanding of the life context of pregnant patients and identify those who are most vulnerable or might be struggling with substance use. Preis stresses that addressing their needs has great potential to improve the health and well-being of pregnant women and their children.

Co-authors and collaborators on the PROMOTE project include: Marci Lobel, PhD, Department of Psychology and Department of Obstetrics, Gynecology and Reproductive Medicine; Cassandra Heiselman, DO, Department of Obstetrics, Gynecology and Reproductive Medicine; Ayesha Azeem, RSOM student and first author of the publication; David Garry, MD, Department of Obstetrics, Gynecology and Reproductive Medicine.

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SUMMARY POINTS

• Race influences the treatments of opioid use disorders.
• There is an opioid crisis and a health disparities crisis.
• Racial equity should include increasing access for treatment, funding harm reduction programs and expanding community-based services such as employment, housing, and recovery support for those with opioid use disorder. 

 

 

ANALYSIS

Background

The United States listed the opioid crisis as a public health emergency (1). Concurrently, the United States has a racial health disparities crisis that is evident as patients from various races receive different health care treatments (2). The opioid crisis has impacted all racial groups, with incidence rates of 11.9, 9.3%, and 9.6% in the White, Black, and Hispanic populations, respectively(3). 

Multiple studies have listed that racial disparities in pain treatment are associated with lower opioid use in minority patients during the beginning of liberalized opioid use in clinical settings (4). Disparities in pain treatment usually involve decreased access to medication by the patients, and biases in pain assessment and management by healthcare providers; and differential workers compensation for pain-related claims (5). A meta-analysis utilizing data from  1989-2011 found that Hispanic and Black patients had a 22% and 30% lower rate of obtaining an opioid prescription compared to white patients, respectively (5). In 2010, due to better regulation of opioid prescriptions, heroin use and other synthetically produced opioids increased, leading to a crisis of opioid related deaths (6).

Opioid Use Disorder (OUD) is the chronic use of opioids that leads to habitual drug seeking and includes reduced self-control, participation in risky behavior and social impairments (7). Although treatment for OUD, discrimination continues to affect the care provided to the minority population (7). It is known that treatment for OUD can reduce the overdose rate, increase patient involvement in addiction programs when discharged and decrease overall health care utilization (8). Unfortunately, communities that have a higher number of Black and Hispanic residents have reduced health care resources that can provide the recommended interventions for OUD. When controlling for factors such as overdose burden, socioeconomic status and hospital risk factors; minority communities are still less likely to have access to essential harm reduction services(8). 

FIGURE 1: U.S Drug Overdose death rate 

[SEE ARTICLE from the CDC]

 

Analysis

Only 20% of patients with OUD get treatment despite the studied benefits such as reduced risk of mortality (10). Research has shown that racial minorities are less likely to obtain treatment for OUD from health care providers when compared to white counterparts(8). In 2019, Black and Hispanic with diagnosed OUD were 30% less likely than White patients to be offered treatment (11). 

There have been numerous public strategies taken to improve opioid misuse. Unfortunately, public health campaigns primarily focus on White communities and ultimately decreased the rate of OUD and opioid related death for White patients alone rather than the combination with minority patients (12). As a result of minority patients receiving less community support and resources for OUD, individuals resort to self-medicating with fentanyl and heroin which increases opioid misuse within these populations (12). In 2019, opioid related mortality rates decreased by 0.3% in White patients but increased by 20% in Black patients (13). 

A quantitative analysis on the intersection of race and opioid use disorder treatment observed how race influences treatment for OUD. This study used patient information from the Treatment Episode Data Set Discharges (TEDS-D), a nationwide study utilizing data of patients discharged from substance use disorder (SUD) treatment programs (14). The dataset includes information on treatment episodes and admissions to SUD treatment programs including programs in public and privately owned facilities. TEDS-D also included information from institutions such as state prisons. The study only used information from patients with a DSM-IV diagnosis of OUD between 2013 to 2017. From this data, researchers observed that being a minority is linked with a reduced chance of being referred to treatment by a healthcare worker. Data also showed that compared to their White counterparts, minority patients had a reduced likelihood of receiving appropriate OUD medication as part of the treatment plan. This study, as with many others, concluded that change is required to address this problem. This study primarily focused on policymakers and how to implement these findings to create interventions for OUD that acknowledge race. Public health interventions could help to address the discrepancies in treatment gaps that this study identified.

Discussion

Additional studies are needed to develop more efficacious strategies to address race for OUD. Across multiple studies, it is noted that areas with more economic instability and distress reported higher drug use. There are other factors discussed such as income, housing instability, transportation, insurance, biases, and mistrust in the healthcare system that influence access to treatment. Interventions in the local, state, and national policy levels are critical to tackle these issues. 

Interventions such as linkage and retention in care while not criminalizing patients with OUD and access to treatment and harm reduction services are beneficial in minority communities. Ultimately, intervention and prevention strategies must include evidence based and culturally receptive tools that use social determinants of health to reduce biases surrounding treatment. These tools include culturally targeted campaigns and hiring community prevention liaisons or ambassadors to assist with decreasing mistrust and increasing accessibility to treatment and reduction services. Opioid misuse is preventable. Integrating efforts with an emphasis on childhood experiences that increase the risk for OUD, as well as applying trauma-informed care, is essential for improving minority communities that have been affected by years of discriminatory policies.