Category: From Newswise – Addiction

Newswise — PHILADELPHIA— Patients who are younger or who haven’t taken opioid pain medication before are more likely to not need any after many common surgeries, according to new research from the Perelman School of Medicine. Additionally, the study, published in Annals of Surgery Open, showed that simply understanding a patient’s history with opioids and how they are feeling upon leaving the hospital could help clinicians tailor the amount of prescription pain medicines they may need as they transition home.

“At face value, it seems quite simple that asking patients about their pain and use of pain medicine would help inform what we do, but it is often easy to lose sight of the value of these patient-informed moments,” said first author Anish Agarwal, MD, an assistant professor of Emergency Medicine and the deputy director of the Penn Medicine Center for Insights to Outcomes. “These are simple data points, but they could be used in a high impact way to help manage pain, tailor prescribing, and support clinicians who are trying to better balance the risks of opioids while addressing expected pain following surgery.”

The study, co-led by Kit Delgado, MD, an associate professor of emergency medicine and epidemiology and the director of the Penn Medicine Nudge Unit and co-chair of the Penn Medicine Opioid Task Force, used data collected through automated text messages sent to approximately 3,600 patients who had one of the 30 most common surgical procedures at the University of Pennsylvania Health System. Mostly, these surgeries fell under the umbrella of orthopaedic (such as hip or knee procedures) or neurosurgery (spine or back procedures).

Among the questions surgery patients were asked via text message were whether they filled their opioid prescription, their pain level on a scale of one to ten, how well they felt they could manage the pain, and how many opioid tablets they actually used.

“Previously, our team had used this automated text messaging program to generate procedure-specific guidelines, and these guidelines recommended a default quantity that would cover most patient needs, though most would need less and some needed more,” Delgado said. “We wanted to use the data to identify some common factors that could guide clinicians to “right size” prescriptions based on a patient’s personal characteristics.”

Overall, of patients who hadn’t taken opioids before (termed opioid naivety), more than half used either none or less than five of the opioid tablets they’d been prescribed. The researchers found that in hip replacements, patients who were opioid naïve and rated their pain low when being discharged used an average of about five opioid tablets while patients who had used opioids before and rated their pain high at discharge used an average of 20 tablets.

And in procedures where the hospitals’ guideline was to prescribe 15 opioid tablets or fewer, patients who were in the lowest age bracket (18-34 years old) and who hadn’t taken opioids before were significantly likely to not take any of the pain medication they were prescribed or, if they did, take just five tablets or fewer. The same held true in procedures where 20 opioid tablets were recommended.

Could it be possible that the opioid epidemic and new attention around it is affecting the way younger patients — who came of age during this time period — use pain medication?

“We know that clinicians are trying to prescribe fewer opioids and, anecdotally, we hear that patients have more concerns about opioid use,” said Agarwal. “Nonetheless, there are instances where opioids, when taken in limited quantities and for short periods, are effective tools to help patients manage severe pain – for instance after a major surgery. We’re hoping this work can alleviate some concerns, as well as some of the issues surrounding leftover medications.”

Because the researchers found a correlation between use of opioids and the severity of pain that patients reported upon discharge, the researchers believe that simple measures can be used in the moment by clinicians to help adjust prescriptions to specific patient needs. For example, if a patient reports their pain as a “3,” giving them the same amount of opioids than a patient rating their pain an “8” may not be necessary. And, by extension, that could help cut down on the leftover opioids after surgeries that can be misused and circulated.

For example, in hip replacements, again, the opioid naïve, low-pain patients only needed about five tablets of opioids. But opioid naïve patients who underwent the same procedure and rated their pain as high needed almost 15 tablets, on average.

This research extends other work by Agarwal, Delgado, and their colleagues seeking to cut down on the possibilities of having leftover opioids after surgeries. That includes mailing order disposal kits and using a texting program similar to the one in this study to monitor how many opioids patients used, in real-time.

“The next steps here are to take this research and translate it into actual clinical practice,” Agarwal said. “We’ve already used the feedback from our patients to help support our existing guidelines, and with this data our clinicians can become even more specific to personalize the approach to pain management for patients. We are beginning to see opportunities to help create new pathways for clinical decision support across large systems and for thousands of patients, but in a way that is still personalized based on their history and pain trajectory.”

This study was funded through the Food and Drug Administration (HHSF223201810209C).

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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.

The Perelman School of Medicine is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.

The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

Penn Medicine is an $11.1 billion enterprise powered by more than 49,000 talented faculty and staff.

Newswise — In 2021, 61.2 million Americans ages 12 and older used illicit drugs and more than 106,000 died from drug-involved overuse. Florida ranks second to California, with 5,300 annual overdose deaths, outpacing the national average by about 23 percent. Excessive alcohol use is the leading cause of preventable death in the United States and is associated with numerous health issues, including heart disease, cancer and poor mental health.

Although individuals with substance use disorder use outpatient sober support services and resources, relapse rates are still as high as 70 percent, indicating a need for more treatment modalities. 

A new Florida Atlantic University pilot study is showing promise in treating addiction cravings by combining eye movements and guided instructions to process memories. The evidence-based therapy – Eye Movement Desensitization Reprocessing (EMDR) – has proven to be effective in treating PTSD, depression, anxiety and other mental health conditions. However, research exploring this method for substance use disorder is sparse.

Since cravings are maintained and heightened by sensory imagery stored in memories, with more vivid imagery predicting higher craving intensity, one of the goals of the FAU study was to transform dysfunctional memories stored in the brain through processing and integration. Addiction memory, assumed to be episodic, resembles the maladaptive traumatic memory formation commonly seen in post-traumatic stress disorder.

“Because Eye Movement Desensitization Reprocessing has been shown to reduce the vividness of negative memories associated with trauma, we anticipated that this therapy would also reduce the vivid imagery that fuels addiction cravings,” said Elizabeth Woodruff, first author, a graduate of the Phyllis and Harvey Sandler School of Social Work within FAU’s College of Social Work and Criminal Justice, and a practicing clinical therapist in West Palm Beach. “This method accesses trauma events in very specific ways to reprocess what the individual remembers from the negative event to ‘repair’ the mental injury from that memory.”

FAU’s “Addiction-focused Eye Movement Desensitization Reprocessing” study focused on cravings, perseverative thoughts (repetitive negative thinking), and irrational cognitions about the substance of choice. For the study, researchers tested Addiction-focused EMDR with and without cognitive behavioral therapy, a psycho-social intervention aimed to reduce symptoms of various mental health conditions including depression and anxiety disorders. 

Results of the study, published in the Journal of Evidence-based Social Work, showed a significantly high participant retention rate (nearly 100 percent). Addiction-focused EMDR was as effective as cognitive behavioral therapy for cravings with the combination of both resulting in more reduction in craving than cognitive behavioral therapy alone. Both groups (experimental group and control group using only cognitive behavioral therapy) had clinically significant reductions in cravings, perseverative thoughts, and irrational cognitions, with the experimental group showing greater decreases overall.  

“While the purpose of our pilot study was to test Addiction-focused Eye Movement Desensitization Reprocessing on chemical addiction cravings, our findings indicate that it also can be highly effective with issues that are not chemical but rather compulsory in nature, such as Internet addiction and gambling. However, more randomized control trials are necessary to confirm our findings and develop a transparent understanding of the number of sessions needed to cultivate statically significant outcomes that are replicable for future studies,”  said JuYoung Park, Ph.D., second author and a professor in FAU’s Phyllis and Harvey Sandler School of Social Work. “Importantly, this therapy is a valuable add-on to current addiction treatment to address memories that drive addiction cravings, which also impacts maladaptive thought patterns associated with relapse.” 

EMDR is an eight-phase intervention: in-depth client history, preparation, assessment, desensitization, installment, body scan, closure and reevaluation.

Participants in the experimental group received 60 minutes of individual cognitive behavioral therapy once a week, followed by Addiction-focused EMDR. Researchers explored past memories of relapse (first, worst, most recent) and cravings (first, worst, most recent) and current triggers. They identified future fears, which were desensitized with Addiction-focused EMDR.

Nearly 57 percent of the study participants reported alcohol as their primary substance dependence and 20 percent reported heroin or other opiates, including morphine, as their primary substance dependence.

Currently, individuals with substance use disorder are encouraged to attend inpatient treatment that employs group therapy to educate patients on addiction, coping skills, and thought-stopping techniques, and cognitive behavioral therapy, along with pharmacological options such as anti-craving drugs.

As perseverative thoughts were found to be an important predictor of relapse, the researchers say findings from their study show that pairing Addiction-focused EMDR with cognitive behavioral therapy, could decrease relapse rates and help people with substance use disorder to maintain long-term recovery in inpatient or even outpatient treatment centers.

Study co-authors are Heather Howard, Ph.D., associate professor; Manny Gonzalez, Ph.D., associate professor; both in FAU’s Phyllis and Harvey Sandler School of Social Work; and Talib Jaber, RPh, vice president of customer success, Sunwave.  

– FAU –

About Florida Atlantic University: Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.fau.edu.  

Newswise — Medical cannabis legalization is associated with a decrease in the frequency of nonmedical prescription opioid use, according to a Rutgers study. 

The study, published in the International Journal of Mental Health and Addiction, examined data from a nationally representative survey of adults who reported nonmedical prescription opioid use – or using prescription medications without a prescription or in a manner other than prescribed.

According to the study, when states implement medical cannabis laws, there is a 0.5 to 1.5 percentage point decrease in regular to frequent (up to or greater than once per week on average) nonmedical prescription opioid use among people who reported using opioids in the previous year. However, these reductions were concentrated in people who met diagnostic criteria for cannabis addiction.

Still, the pros of legalizing marijuana to address risky opioid use should be considered alongside the cons, according to Hillary Samples, faculty member at the Center for Pharmacoepidemiology and Treatment Science in the Rutgers Institute for Health, Health Care Policy and Aging Research and lead author of the study. 

“There might be some benefits to allowing legal access to medical cannabis in the context of opioid-related harms,” Samples said. “However, from a policy perspective, there are much more effective interventions to address the ongoing overdose crisis, such as increasing access to treatment for opioid addiction.”

According to the Centers for Disease Control and Prevention, the rate of drug overdose deaths rose more than 14 percent from 2020 to 2021 in the United States. To understand approaches to mitigate this crisis, researchers have examined whether cannabis serves as an alternative to opioid use as cannabis might help with pain and symptoms of opioid withdrawal.

With existing research showing mixed findings on the relationship between medical cannabis legalization and opioid use, a team of researchers led by Samples sought to contribute to this evidence.

Samples, an assistant professor of health systems and policy at the Rutgers School of Public Health, said the results suggest people may be replacing opioids with cannabis, but because the decrease in opioid use is modest and limited to high-risk cannabis users, study researchers call for investment in opioid addiction treatment.

The researchers said future studies should seek to understand whether the reductions in the frequency of nonmedical opioid use are meaningful in relation to the widespread opioid addiction crisis as well as whether the reductions in opioid use coincide with increases in cannabis use disorder.

“Policymakers should weigh the overall evidence on the effectiveness of various approaches to reduce opioid-related problems and consider potential trade-offs,” Samples said.

Coauthors of the study include Natalie Levy, Emilie Bruzelius, Luis Segura, Pia Mauro, Christine Mauro and Silvia Martins of the Columbia University Mailman School of Public Health and Anne Boustead of the University of Arizona.

As you plan health coverage over the next few weeks, Ochsner Health has medical experts on standby to cover a variety of topics.

• What causes epilepsy and what are the most common signs? – November is National Epilepsy Awareness Month, and there are a lot of questions that often surround this medical condition.  More than 4 million adults in the United States have had a diagnosis of epilepsy or seizure disorder; it’s also a common diagnosis in children. Most cases of epilepsy have no identifiable cause. An Ochsner doctor can share common misconceptions about epilepsy, symptoms to look out for and information to help navigate a diagnosis.                                                   
• Is your body telling you to get checked for Type 2 diabetes? – If you experience extreme thirst, tiredness or urinating more often than usual, you may have Type 2 diabetes. In Gulf Coast states, the rate of those with diabetes is above average. It is estimated that tens of thousands of people have diabetes and may not know it, significantly increasing their health risk. An Ochsner doctor can explain ways your body may be telling you to get checked for Type 2 diabetes.
• Thanksgiving Turkey Safety Tips – Nothing says Thanksgiving like a delicious roasted, fried or baked turkey. Whether you are a seasoned or new home chef, safety should be top of mind while preparing your Thanksgiving feast. Urgent cares and emergency rooms see a spike in knife and burn injuries during the holidays. To keep this holiday season safe, an Ochsner doctor can review some helpful tips.
• 5 reasons to quit smoking  – November is Lung Cancer Awareness Month, and cigarette smoking is the number one cause of preventable death in the United States. But if you need even more reasons to quit, our Ochsner doctors have plenty –from saving money to looking and feeling better.
• Why heart attacks are more common around the holidays? – More people have heart attacks in December and January than at any other time of the year due to excessive alcohol, lack of exercise and food overconsumption – all hallmarks of the holiday season. The holidays are also accompanied by high levels of stress and depression which can also lead to an increased risk of cardiac events. An Ochsner doctor can tell you how to minimize risk this season.
• What are the top Christmas tree allergy symptoms? – You’ve just returned home with your fresh Christmas tree, and the family is excited about getting it set up and decorated for the holidays. But after a day or two, you start sneezing and feeling short of breath. What’s going on? An Ochsner doctor can explain “Christmas tree syndrome.”                                           
• Holiday Safety Tips for Kids – It’s the most wonderful time of the year! And there are many things for parents to keep in mind to make it a safe time of year as well. From Christmas trees and decorations, to toy and food safety, an Ochsner pediatrician can share tips for ensuring your kids have a safe and enjoyable holiday this season.                                                           
• Cold and Flu Myths – As cold and flu season continues, it’s important to consider getting a flu vaccine if you haven’t already this year. An Ochsner doctor can share some of the most common myths related to the flu vaccine, common cold & flu symptoms, and tips for staying well this season.
• Tips to manage postpartum depression during the holidays – We often imagine the holidays to be a joyous, happy time where we can be with family and celebrate the good times. But for some new moms experiencing postpartum depression, the holidays can be a particularly difficult time and they might not feel up to celebrating. An Ochsner doctor can share tips for managing postpartum depression during the holidays.

Newswise — November 8, 2023 — Among cancer patients, psychological distress and accessibility of opioids often lead to chemical coping, a middle ground between addiction and proper adherence to a medication regimen. Chemical coping can diminish quality of life and interfere with pain and symptom management, as well as predispose individuals to developing substance use disorder. The findings are reported in the Harvard Review of Psychiatry (HRP), part of the Lippincott portfolio from Wolters Kluwer.  

Miryam Yusufov, PhD, a psychologist in the Department of Psychosocial Oncology and Palliative Care at the Dana-Farber Cancer Institute, a Harvard Medical School teaching hospital in Boston, and colleagues have developed the first conceptual model that integrates the risk factors that initiate and maintain chemical coping with opioids during cancer care. “This model will help care teams triage factors that require monitoring and potential risk mitigation . . . as well as those that require behavioral intervention,” the research team notes.  

Predisposing risk factors identified in four overlapping domains 

Based on a search of medical literature in PubMed and MEDLINE, the team found that risk factors and treatment targets for chemical coping in cancer can be organized according to whether they are historical or current and whether they are malleable (amenable to intervention) or unmalleable. The researchers describe the evidence base for each risk factor, some of which fall into multiple domains: 

• Historical and malleable factors: Depression, anxiety, posttraumatic stress disorder, and other psychological diagnoses; intolerance of distress 

• Current and malleable factors: Chronic pain, psychological diagnoses, deficit in coping skills, opioid availability 

• Historical and unmalleable factors: Family history of substance use disorder, including alcohol use disorder; personal history of substance use disorder; history of sexual victimization; childhood abuse  

• Current and unmalleable factor: Age 16 to 45 

“Therefore, patients with no misuse behaviors are still at risk for chemical coping based on these preexisting risk factors and long-term opioid therapy,” the authors say. 

Implications for clinical practice: universal screening, patient education, and mental health care 

Dr. Yusufov and her colleagues recommend screening all patients for risk of chemical coping before initiating opioid therapy. They point out that “it is less stigmatizing to address chemical coping risk than active misuse of opioids.” For example, the Opioid Risk Tool (ORT) addresses family and/or personal history of substance use, history of sexual abuse/violence, and psychological disorders.  

Given the recent upward trend in opioid-related hospitalizations among patients with cancer, the authors suggest clinicians may mitigate overdoses and deaths with patient education on naloxone and medication return policies upon therapy completion or regimen changes. 

Finally, the proposed model can aid in selecting components for behavioral interventions and help clinicians determine when to refer patients to psychosocial support resources. This approach can maximize cost-effectiveness while minimizing risk. “For example, if a patient presents with predominantly malleable factors, they may be an appropriate candidate for psychosocial support,” Dr. Yusufov’s team says. “If a patient presents with predominantly unmalleable factors, however, they may be a more appropriate candidate for continued monitoring throughout opioid therapy.”  

Read Article [ Toward a Psychological Model of Chemical Coping with Opioids in Cancer Care ] 

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.  

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About HRP 

Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer-reviewed and not industry-sponsored. It is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. 

Articles encompass all major issues in contemporary psychiatry, including (but not limited to) neuroscience, psychopharmacology, psychotherapy, history of psychiatry, and ethics. In addition to scholarly reviews, perspectives articles, and columns, the journal includes a Clinical Challenge section that presents a case followed by discussion and debate from a panel of experts. 

About Wolters Kluwer  

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.  

Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,900 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. 

Newswise — Online shopping for cigarettes and vaping products increased significantly in the weeks following the implementation of SB-793, a 2022 California law prohibiting the sale of flavored tobacco products. Researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego identified potential loopholes in tobacco control policies due to the absence of explicit regulations on e-commerce sales in retailer licensing programs.

Reporting in the journal Tobacco Control on Nov. 7, 2023, researchers assessed the impact of California’s statewide flavor restriction on online shopping behavior among consumers. Comparing observed rates of shopping queries with expected rates, researchers discovered that shopping queries were 194 percent higher than expected for cigarettes and 162 percent higher than expected for vape products.

“Retailer licensing programs have proven to be effective in enforcing tobacco control laws. However, the exclusion of e-commerce retailers from these programs can undermine their impact,” said principal investigator Eric Leas, PhD, MPH, an assistant professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego and director of the Tobacco E-commerce Lab.

Despite the flavor restriction imposed by SB-793, analysis of the first 60 websites returned in the search queries presented at least two online retailers offered access to flavored vaping products or menthol cigarettes to consumers in California — with one query returning as many as 36 websites (60 percent of the search results) — highlighting the potential shortcomings of retailer licensing programs that do not include e-commerce retailers in their regulations.

“The absence of explicit regulations on e-commerce sales can create loopholes in enforcing tobacco control laws, allowing consumers to easily access restricted products online,” said Leas. “By including e-commerce in the definition of ‘tobacco retailer’ and ensuring strict compliance monitoring, we can close these loopholes and improve the effectiveness of tobacco control policies.”

To address these concerns, the study authors recommend strengthening regulations to include e-commerce retailers within the scope of retailer licensing programs. Additionally, they emphasized the importance of monitoring online compliance to ensure the effectiveness of laws enforced through retailer licensing programs.

“The study’s findings have important implications for policymakers and public health advocates, emphasizing the need for comprehensive regulations that address the challenges posed by the growing e-commerce market for tobacco products,” said Leas.

Co-authors include: Tomas Mejorado, Raquel M. Harati, Shannon E. Ellis, Nora Satybaldiyeva, and Nicolas E. Morales, all of UC San Diego; and Adam Poliak, Byrn Mawr College.

This research was funded, in part, by the Tobacco Related Disease Research Program (T32IP4684).

Disclosures: The authors do not have any conflicts of interest to report.

Title: The E-Commerce Licensing Loophole: A Case Study of Online Shopping for Tobacco Products Following a Statewide Sales Restriction on Flavored Tobacco in California

DOI: http://dx.doi.org/10.1136/tc-2023-058269

Newswise — Artificially causing – or inducing – labor is becoming increasingly common, yet this practice comes with risks and its level of success is difficult to foresee. But now, new research may offer a way to help predict outcomes and improve the process.

Researchers at the University of Arkansas for Medical Sciences (UAMS) have devised a non-invasive method of accurately measuring the electrical activity of uterine muscles. The results of a recent clinical study, published in the journal Current Research in Physiology, show that signals measured in pregnant patients prior to induction are strongly tied to whether their labor lasted less or more than 24 hours. The authors indicate that physicians could use the method to learn how patients might respond to induction and use the information to develop more effective strategies for labor and delivery.

If a pregnant person or their baby’s health would benefit from beginning labor sooner, health care providers may recommend inducing the process through medication or other means. Without any reliable monitoring instruments, physicians heavily rely on physical examinations and their experience to inform induction strategies.

Taking this approach, time spent in labor varies greatly from patient to patient and there is also a risk of excessive doses of induction medication causing harm.

“Sometimes women will sit there for 36 hours after being induced and nothing’s happening,” said Hari Eswaran, Ph.D., professor of obstetrics and gynecology at UAMS. “We wanted to know when the uterus is prepared for labor. If we capture a physiological signature beforehand that indicates the chances of successful induction, that information can be used to personalize the approach.”

In search of telling cues, Eswaran and his co-authors previously developed the Superconducting Quantum Interference Device (SQUID) Array for Reproductive Assessment, or SARA for short.

Gauging the electrical activity of various parts of the body through techniques such as electromyography, or EMG, is routine in the clinic. However, electrical signals from the uterus weaken by the time they reach the surface of the skin, making them particularly challenging to detect.

Instead of directly measuring electrical activity, SARA takes a back door.

Electrical current, whether passing through power cables or the muscles of the human body, always generates a magnetic field around it. And if you can detect the field, then you can work backwards to calculate the electrical current that produced it, Eswaran explained. This is the approach the researchers are taking with SARA’s array of 151 biomagnetic sensors.

In the new study, the authors analyzed measurements taken from 27 patients that were between 37 and 42 weeks pregnant. Each rested their abdomen on SARA’s sensors, which recorded the magnetic activity produced by the uterus prior to induction. The authors converted the magnetic signals into metrics related to the electrical activity, such as power. After noting how long it took for each patient to deliver, the authors examined their data and picked up on a significant pattern.

Patients that delivered their babies within 24 hours after induction exhibited four times as much uterine electrical power across entire recordings than those in labor for longer.

While none of the patients were experiencing contractions while SARA recorded signals, the results suggest that those with higher uterine electrical power were more prepared for labor, Eswaran explained.

Equipped with a tool that could help predict responsiveness to induction, physicians would be better informed in devising strategies tailored to individual patients. With further research, SARA could become such a tool, potentially providing guidance on when to administer induction medication and in what doses, which would lead to safer and more efficient labor and delivery.

“NIBIB provided grant funding over 15 years ago to support the development of the novel computational methods used in this clinical trial to predict labor contractions with SARA,” said Grace C.Y. Peng, Ph.D., director of the NIBIB program in Mathematical Modeling, Simulation and Analysis. “It is so rewarding to see this project demonstrate the translational potential of computer models to improve the quality of care in women’s health.”

This research was funded in part by a grant from NIBIB (R01EB007264).

This Science Highlight describes a basic research finding. Basic research increases our understanding of human behavior and biology, which is foundational to advancing new and better ways to prevent, diagnose, and treat disease. Science is an unpredictable and incremental process—each research advance builds on past discoveries, often in unexpected ways. Most clinical advances would not be possible without the knowledge of fundamental basic research.

Study reference: Sarah Mehl et al. Assessing uterine electrophysiology prior to elective term induction of labor. Current Research in Physiology (2023). DOI: 10.1016/j.crphys.2023.100103

Newswise — COLUMBIA, Mo. — The rate of opioid use among pregnant women in the United States quadrupled between 1999 and 2014 and continues to rise — an alarming trend that researchers from the University of Missouri and University of Iowa say has exposed the stigma felt by opioid-dependent mothers and how their shame has negatively impacted the health care received by their infants.

Jamie Morton led a study, which was a metasynthesis of existing literature on the topic, as a doctoral student at the MU Sinclair School of Nursing. She said the findings can help ensure health care providers, family members, friends and community members emphasize messages of support and compassion toward opioid-dependent mothers during the perinatal stage, which in this study was defined as one year prior to conception, pregnancy, and up to 18-24 months postpartum.

“We found that because the mothers were made to feel badly about themselves, they would withdraw themselves from receiving health care,” Morton said.

Morton added that since the mothers were often not getting any emotional or social support from health care providers, family, friends or community members, they felt self-blame and would internalize the stigma.

“What was surprising was the stigma was also transferred to the baby, a term known as associative stigma. The moms felt their infants were not given the same level of care or were treated differently,” Morton said. “The moms would just withdraw from even receiving health care in the first place in an effort to protect their child from being stigmatized, so they were less likely to take their baby to the pediatrician and less likely to take advantage of developmental services for their baby.”

Morton explained that this sometimes led to the mothers being referred to as “noncompliant” or “bad mothers.”

The researchers analyzed and synthesized 18 qualitative studies involving women of childbearing age in the U.S. who expressed feeling stigmatized due to their opioid dependence during the perinatal stage, as well as how the stigma impacted the health care they received for themselves and their babies.

“How often do we hear the phrase ‘the apple doesn’t fall far from the tree’?” Morton said. “Personally, I think everyone should be given a chance and treated with the same kindness and compassion as anyone else.”

Morton formerly worked in a newborn nursery and remembers mothers that would be very withdrawn.

“I made it a point to just treat them as any other mom, because all moms deserve our support as nurses and health care providers,” Morton said. “We just need to promote the opportunity for them to still be at the center of their health care decisions regarding both them and their babies as well as promoting their role as a mom.”

The research could potentially lead to more formalized education that could include trauma-informed care, topics such as trust, active listening, unconscious bias, and not judging based off assumptions. This could result in opioid-dependent mothers feeling more comfortable accessing care for themselves, taking their baby to the pediatrician or taking advantage of developmental services for their baby. This would ultimately improve both the mom’s and the baby’s long-term health outcomes.

“This expands way beyond nurses and health care providers, who, in general, do a great job of showing support, kindness, and compassion to the patients they serve,” Morton said. “This expands to the importance of family, friends, community members and the general public showing support, kindness and compassion. It is an honor and privilege to elevate the voices of these vulnerable women because their voices are not typically heard, but they need to be so we can meet their health care needs.”

“Stigma experienced by perinatal women with opioid dependency in the United States: A qualitative metasynthesis” was recently published in the Western Journal of Nursing Research. Funding was provided by the National Institutes of Health through a training grant awarded to the MU Sinclair School of Nursing.

Newswise — Rutgers researchers have used neuroimaging to demonstrate that cocaine addiction alters the brain’s system for evaluating how rewarding various outcomes associated with our decisions will feel. This dampens an error signal that guides learning and adaptive behavior.

The observed changes likely propagate a mysterious aspect of some addictive behavior—the tendency to keep doing harmful things that sometimes have no immediate benefit. Those changes also make it harder for long-term users of cocaine to correctly estimate how much benefit they’ll derive from other available actions.

Experts have long hypothesized that cocaine and other addictive substances can influence “reward prediction errors,” a computation the brain performs to guide learning about what is valuable in one’s environment. The substances were thought to increase reward prediction errors by interfering with the neurotransmitter dopamine’s activity, but concrete evidence for alterations in this critical brain function in people with chronic cocaine addiction has eluded researchers.

The new study, which appears in Neuron, provides strong evidence and could suggest new strategies for treating addiction in general and cocaine addiction in particular.

“The brain has sophisticated mechanisms for predicting which behaviors will bring us pleasure and pain, for updating predictions that prove incorrect and for learning how rewarding different behaviors actually are,” said lead author Anna Konova, a psychiatry professor who leads a research lab at the Rutgers University Behavioral Health Care and Brain Health Institutes.

“This sort of learning from experience is one of the most important things people do. It’s why you don’t touch a hot stove more than once. This study demonstrates that people with chronic cocaine-use disorders could struggle to learn in this way. It also shows why they struggle, and, hopefully, this understanding of the underlying mechanism will lead to better treatment options,” said Rita Goldstein, Mount Sinai Professor in Neuroimaging of Addiction at the Icahn School of Medicine who is senior co-corresponding author on the study.

The researchers studied the brain’s prediction error mechanism by recruiting people who had been using cocaine for an average of 18 years and asking them to play simple decision-making games (with small monetary rewards that could be received either for sure or by chance) — all while undergoing a functional magnetic resonance imaging (fMRI) scan. The researchers then asked the same of another group of participants who had never used cocaine but resembled the first group in many other ways.

The group of participants that had used cocaine consistently pursued riskier playing strategies. They also had lower neural error signals when an unexpected reward was delivered or omitted as a result of those riskier decisions.

The brain’s response to mistaken predictions, the response needed to encode an error’s occurrence and avoid repeating it, was significantly lower among the cocaine-using group than among the other participants.

Such findings strongly implicate the physiological effects of chronic cocaine use on the observed differences in brain function, but the researchers note that a snapshot of brain function at a single point in time cannot prove causation. Only a study measuring brain structure and function over time, starting before the onset of cocaine use, would be able to test hypotheses about cause and effect.

That said, Konova and Goldstein believe the study results provide strong new evidence about one cause of cocaine addiction and the changes it creates in user behavior. They also hope a greater understanding of the underlying mechanisms may help develop treatment options, which remain limited.

“Although this basic science study does not have any immediate implications for public health or treatment, researchers can build on these findings to explore new treatments and prevention strategies,” Konova said. “Specifically, our findings suggest that interventions that aim to boost the impact of the outcomes of one’s decisions (the perception of received rewards) may be a valuable strategy to normalize prediction error signaling and learning from experience in addiction.”

UNDER EMBARGO UNTIL
Wednesday, October 25 at 11am EST
Media Contact: Elizabeth Dowling
Mount Sinai Press Office

Dysregulation of the Brain’s Reward Learning System Is Identified by Scientists as a Potential Driver and Treatment Target for Cocaine Addiction 

Newswise — New York, NY (October 23, 2023) –A Mount Sinai-led team of researchers has shed new light on the ways in which cocaine addiction dysregulates the normal function of dopamine neurons and thus the brain’s ability to process and respond to reward-related information, making it more difficult for individuals to change their addictive behaviors.

Their insights into the neural mechanisms that mediate and maintain continued cocaine use, reported in the journal Neuron, could potentially lead to interventions to modify and even prevent this addiction.

“Previous research, mostly in animal models, has suggested that chronic cocaine use degrades the normal functioning of dopamine, a neurotransmitter widely implicated in reward, motivation, and learning,” said Rita Z. Goldstein, PhD, the Mount Sinai Professor in Neuroimaging of Addiction at the Icahn School of Medicine at Mount Sinai and senior author of the work.

“In people with chronic cocaine addiction we observed a striking reduction in the way their reward system—a set of connected regions along the brain’s dopamine pathways—responds to the outcomes of the person’s decisions,” Dr. Goldstein added. “Instead of signaling clearly when an unexpected reward was received and broadcasting this information throughout the brain to inform future decisions, the signal was attenuated, making it harder to learn from experience and modify decision-making to obtain better outcomes. This finding could potentially inform therapeutic strategies to target addictive cocaine use behaviors, which are especially difficult to change since this system is not functioning properly.”

The study was designed to investigate whether people with chronic cocaine use disorder demonstrate differences in how their brains process and represent prediction “errors”—discrepancies between what an individual expects to receive as a reward and what they actually receive. This difference is used as a “teaching signal” by the brain to guide learning and adaptive decision-making.

For their study, researchers used a simple decision-making task inspired by studies of dopamine neurons in animal models to measure different kinds of reward responses in the ventral striatum, a brain region that receives dense dopaminergic inputs. The results showed that prediction error responses in the ventral striatum reflected “utility” prediction errors—errors that incorporate an individual’s subjective experience of reward as informed by their unique preferences for risk and uncertainty. Importantly, utility prediction error responses were found to be significantly reduced in people with cocaine addiction, who were generally more risk-tolerant, especially those who began using cocaine in early adolescence.

“Our work firmly establishes that compared to non-addicted individuals, and despite generally intact reward expectations, people with cocaine addiction demonstrate weaker responses to actual rewards in the brain’s reward system, particularly the ventral striatum,” explains Anna Konova, PhD, Assistant Professor of Psychiatry at Rutgers University and first author on the study. “This is important because these responses are crucial for the fidelity of the prediction error signal as a teaching signal. A reduced reward signal may contribute to addictive behavior by diminishing an individual’s ability to respond to the harmful effects of a drug, or the value of other, healthier alternatives to drug use.”

Researchers suggest that understanding the precise mechanisms of prediction error alterations that drive addiction could lead to novel, targeted interventions designed to restore the aberrant teaching signal. More specifically, their study points out that therapeutic strategies that aim to boost the impact of one’s decisions—namely the perception of received rewards—could be valuable for normalizing prediction error signaling and the ability of the individual to learn from their addiction experiences.

“We’ve gone further than any prior study to characterize the mechanistic source of prediction error disruptions in people with clinically defined cocaine disruption and believe researchers can build on these findings to explore innovative new treatments and prevention strategies,” said Dr. Goldstein. She also serves as Director of the Neuroimaging of Addictions and Related Conditions (NARC) Research Program at Icahn Mount Sinai.

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