Category: From Newswise – Addiction

Newswise — Physicians and other health care professionals who treat the growing number of people living with substance use disorder often hear the same thing from their patients: why didn’t they talk to someone about their problem sooner?

Their instincts are right, said Dr. Aleksandra Zgierska, a professor in the departments of Family and Community Medicine, Anesthesiology and Perioperative Medicine, and Public Health Sciences at Penn State College of Medicine. A conversation with a family member or someone they love can be the catalyst for someone struggling with addiction to get the care they need, she said.

If you’re among those hoping to help, that conversation might seem daunting enough. But when picking your words, choose them carefully, she said.

“Change can start with just a conversation,” said Zgierska, who serves as associate director of the Penn State Addiction Center for Translation and as an advisory board member of the Penn State Consortium for Substance Use and Addiction. “But that conversation can’t be antagonistic. People are not motivated to change based on negative emotions.” Instead, family members and friends should try to be supportive and non-judgmental, because negativity can make things worse.

“Society often treats addiction as shameful or a weakness of character,” she said. “The stigma is pervasive. That situation has to change.”

Be positive

“Use of illicit drugs not only affects physical health, but also mental and social health,” said Brad Linn, assistant professor in the departments of Family and Community Medicine, Neural and Behavioral Sciences, and Psychiatry and Behavioral Health in the College of Medicine. “As a result, it affects relationships.”

Linn advocates for using cognitive behavioral therapy to help substance use patients. Based on the concept that thoughts and behaviors are linked, the approach has proven to be both effective and efficient in treating patients with substance use disorders, he said.

Like Zgierska, Linn suggests family members and friends show support and suppress negativity. “They must say things like ‘I love you and I care about you and I want to see you well,’” he said. His research, in fact, has shown that reducing negative emotions can help bring about the behavioral changes necessary for recovery.

Families should act quickly to help direct those with substance use disorders to clinics and recovery-oriented organizations, Linn said. Work-based employee assistance programs may also provide a route for treatment.

Families must recognize recovery takes time, he added. “It’s possible your loved one will have a relapse,” he said. “It’s important not to see that as a failure, but to recognize that the person is on a long recovery journey and continue to offer love and support.”

Choose the right words

Zgierska suggests jettisoning terms like “addict.” “That implies the person is defined by their struggle with substance use. Referring to them as a person with substance use disorder underscores the fact they exist outside their disease.”

Other words that exacerbate negativity around the illness include “clean,” for someone who no longer uses substances, or “dirty” for someone who does, Zgierska said.

Other words to avoid, according to the National Institute on Drug Abuse:

• User
• Substance or drug abuser
• Junkie
• Alcoholic
• Drunk
• Former addict
• Reformed addict

It’s not just those words used in articles and popular culture that can hurt, Zgierska said. Their use in the home can have a similar effect.

“Let’s communicate, in the right way. I have had patients who say, ‘My parents never talked to me. They didn’t care,’” she said. “And the family says in response, ‘We cared a lot. We just didn’t know what to do or say.’”

Related content:

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

Newswise — Research has revealed for the first time the extent gambling messages saturate UK media coverage and social media during the opening weekend of the English Premier League football season.

The rapid assessment, carried out by the University of Bristol in collaboration with Channel 5 last month, monitored live televised coverage, sports news programming, sports news radio, and social media over the weekend of 11-14 August.  

Key headline findings were:

• A total of 10,999 gambling messages were identified during the weekend across various media channels.
• 6,966 gambling messages were recorded during the six live match broadcasts.
• 92% out of 391 content marketing ads sent by major gambling brands, were not clearly identifiable as advertising – and therefore breaching a key advertising regulation.
• Less than a quarter (20.6%) included gambling harm reduction messages and only 18.7% featured age warnings – leaving the majority without any warnings. 
• There was at least one gambling ad during any commercial break on TalkSport Radio and 600 gambling messages during two hours of Sky Sports News.
• 1,902 gambling ads on social media, generating a total of 34 million impressions (the number of times an advert was seen).

Gambling messages refers to the number of identical messages or references (such as logos) which were exposed to the audience during the weekend and content marketing aims to engage current and potential consumer bases through content that may not be directly related to the promoted product or brand.

Co-lead researcher Dr Raffaello Rossi, Lecturer in Marketing at the University of Bristol Business School, said: “Our research shows gambling marketing during Premier League weekends is inescapable. Football fans are bombarded with gambling marketing through various channels, making it a normal part of football consumption.

“Our study highlights a serious issue with social media gambling marketing – especially content marketing. A staggering 92% of content marketing ads are not clearly identifiable as advertising, breaching key advertising regulations. We urgently need to strengthen those regulations to protect consumers – in particular children, who are especially vulnerable to sneaky advertising.”

Using validated codebooks from prior research, the scope of the study comprised over 24 hours of match broadcasts, 15 hours of Sky Sports News coverage, 14 hours of TalkSport Radio broadcasts, and the scrutiny of gambling ads posted on social media platforms during the specified period.

Across all media channels examined, the study identified a total of 10,999 gambling messages. This high figure illustrates the persistence of gambling marketing during this period, which translates to an average of 2,750 messages per day or 115 messages every hour.

Match broadcasts accounted for the majority of the gambling messaging totalling 6,966 messages (63%), followed by Sky Sports News with 2,014 messages (18%), social media with 1,902 messages (17%), and TalkSport Radio with 117 messages (2%). Social media gambling ads during the weekend amounted over 30m impressions – highlighting its reach and importance in amplifying gambling advertisement.

The analysis of six Premier League matches showcased the dominance of gambling messaging. Within this limited time frame, a total of 6,966 gambling messages were recorded during live match broadcasts. 

The study also revealed the extent gambling advertising in football is in breach of basic advertising regulation. Of the 391 content marketing ads sent by major gambling brands, 92% were in breach as they were not clearly identifiable as advertising.

In addition, out of the 10,999 gambling messages, less than a quarter (20.6%) included gambling harm reduction messages (e.g., BeGambleAware), and only 18.7% featured age warnings, leaving the majority of the gambling messages without any warnings. 

There was at least one gambling advert during any commercial break on TalkSport Radio. Analysis of TalkSport Radio programming found that at least one gambling advertisement was present during any commercial break, demonstrating the continuous promotion of gambling on this platform.

There were 600 gambling messages during two hours of Sky Sports News. During a single two-hour segment of Sky Sports News, 600 gambling messages were shown. This accentuates the prevalence of gambling marketing beyond live sports broadcast, further contributing to the saturation of gambling marketing in the general media landscape.

The study identified 1,902 gambling ads on social media over the Premier League weekend, which generated 34 million impressions (the number of times an ad has been seen). This data highlights the substantial influence and effectiveness of social media as a platform for gambling advertising – with social media emerging as a key channel for gambling marketing, amplifying its reach and impact.

Dr Raffaello Rossi said: “Self-regulation of the gambling industry is completely failing.  The gambling industry’s primary goal is profit, not public welfare. So, of course they will not implement measures that actually reduce gambling and their profits.  This is why the UK Government has to fulfil its duty and start protecting people from predatory and excessive gambling marketing.

“Other countries such as Italy, Spain, Poland, Netherlands and Belgium have all started to introduce harsh restrictions and even bans on gambling marketing.  It is unbelievable that the White Paper has completely ignored this, and the government is very little to project people from excessive gambling marketing.”

In 2022 the University of Bristol launched the Bristol Hub for Gambling Harms Research to lead pioneering multidisciplinary research into the wide-reaching effects of gambling harms.

The independent hub, funded by a grant of £4 million from GambleAware, facilitates world-leading research to improve understanding of gambling harm as a growing public health issue which needs greater scrutiny and regulation.

Co-lead researcher Dr Jamie Wheaton, Research Associate at the Bristol Hub for Gambling Harms Research, added: “Whilst policies like the whistle-to-whistle and front-of-shirt sponsorship bans are steps in the right direction, they’ve been repeatedly shown to be ineffective. We urgently need comprehensive legislation to regulate gambling messages during matches and beyond, including hoardings, shirts, radio, and social media.

“We believe the whistle-to-whistle ban needs to include all forms of marketing: on hoardings, shirts, and ad breaks, including TV, radio and online.  Other countries have already started to ban gambling marketing from sports – we need to follow their lead.”

Alexia Clifford, GambleAware Chief Communications Officer, said: “Gambling content marketing is almost four times more appealing to children and young people than adults. We also know that young people’s exposure to gambling advertising is associated with a greater risk of gambling harms. The Premier League’s decision to ban gambling companies from front of shirts from 2026 is welcome, but it does not go far enough.

“The Government’s recently published Gambling White Paper is a missed opportunity to strengthen regulation around gambling advertising, marketing and sponsorship in sport, and to protect children.

“If you’re worried about how gambling makes you feel, GambleAware can help. For free and confidential advice, tools and support, search GambleAware or contact the National Gambling Helpline, available 24/7, on 0808 8020 133.”

This research, conducted in partnership with 5 News, will air in a special report on Tuesday 19 September at 5pm on Channel 5, available after broadcast here: https://www.youtube.com/@5NewsUK/videos

Newswise — LOS ANGELES (Sept. 18, 2023) — Pregnant women with a history of substance abuse face a dramatically increased risk of death from heart attack and stroke during childbirth when compared with women without history of substance abuse, a new Smidt Heart Institute study shows.

These findings are published in the Journal of the American College of Cardiology: Advances.  

“This telling research shows that substance use during pregnancy doubled cardiovascular events and maternal mortality during delivery,” said Martha Gulati, MD, senior and corresponding author of the study and the associate director of the Barbra Streisand Women’s Heart Center in the Department of Cardiology in the Smidt Heart Institute. “Substance abuse also doubled the risk of acute heart failure.”

The substances studied in the research included cocaine, opioids, alcohol, amphetamine/methamphetamine and cannabis. Each substance carried a different amount of risk on expectant mothers:

• Amphetamine/methamphetamine had the greatest association with the development of acute heart failure (nine times greater risk), acute heart attack (7 1/2 times greater risk), cardiac arrest (seven times greater risk) and maternal mortality (three times greater risk). These substances are known to increase heart rate and blood pressure and cause structural and electrical changes of the heart.
• Cocaine had the strongest association with stroke and was also found to be associated with arrhythmias, which are abnormal heart rhythms.
• Opioid use had the strongest association with infection of the heart valves—a disease known as endocarditis—which was not surprising given that these drugs are often injected into the bloodstream.
• Alcohol use was associated with the greatest risk for arrhythmias.
• Cannabis—the most commonly used substance—was not associated with maternal mortality. It was, however, associated with a higher risk (twofold greater risk) of heart attack.

“Despite the widespread legalization of cannabis across the nation, many people are unfamiliar with the risks it can pose during pregnancy,” said Gulati, also the director of Preventive Cardiology in the Smidt Heart Institute and the Anita Dann Friedman Endowed Chair in Women’s Cardiovascular Medicine and Research. “Cannabis causes heart cell death and can also lead to severe cardiovascular events.”

To decipher these results, study investigators reviewed data on delivery hospitalizations between 2004 and 2018, using the Nationwide Inpatient Sample database. A total of 60,014,368 delivery hospitalizations occurred during the time frame, with substance use complicating 955,531 deliveries, or 1.6%.

Of the 1.6% of substance-related deliveries, women experienced conditions including heart attack, stroke, arrhythmia, endocarditis, acute cardiomyopathy, heart failure and cardiac arrest.

Investigators say these findings underscore an important public health issue.

“This study highlights the need for additional medical care for pregnant women with substance use,” said Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology.

Albert also suggests that prenatal care for women with a history of substance use should include a multidisciplinary cardio-obstetrics approach with high-risk pregnancy specialists and cardiologists to help identify and minimize adverse outcomes.

“For the wellbeing of pregnant women and their children, substance abuse needs to be considered an independent risk factor for cardiovascular events in pregnancy,” Albert said.  

Read more from the Cedars-Sinai Blog: Understanding Prenatal Genetic Testing and Diagnostics

Newswise — Up to one in four young adults use alcohol and marijuana simultaneously (i.e., use at the same time with overlapping effects), a behavior linked to a greater risk of adverse consequences. Given the expanding legalization of non-medical marijuana use, there is an urgent need to better understand the effects of simultaneous use and who is most vulnerable to adverse outcomes. Previous research has yielded mixed and limited results. For the study in Alcohol: Clinical & Experimental Research, investigators sought to clarify the associations and consequences of simultaneous use in young adults.

Young adults’ simultaneous use of alcohol and marijuana on a given day was associated with consuming more drinks, experiencing more negative consequences from alcohol, and experiencing specific negative marijuana consequences, according to a new study. These findings relate specifically to the simultaneous use of alcohol and marijuana rather than simply the amounts consumed.

Researchers collected data from 409 adults aged 18–25 (50% women, 48% White) in the greater Seattle area who reported recent simultaneous alcohol and marijuana use. Notably, the sample included both college and non-college students. In six bursts over two years, young adults completed 14 days of online surveys, reporting their alcohol and marijuana use and related effects for the previous day. The researchers explored associations between simultaneous alcohol and marijuana use and negative consequences.

Participants reported drinking on 36% of survey days with a mean of 3½ drinks; on 28% of those days, they experienced at least one negative alcohol consequence. They reported using marijuana on 36% of survey days with a mean of three hours high and at least one negative marijuana consequence on 56% of those days. Simultaneous alcohol and marijuana use was reported on 15% of survey days. On days of simultaneous use, participants consumed 37% more drinks and 43% more negative alcohol consequences (e.g., doing something embarrassing, feeling clumsy or confused) compared to drinking days without simultaneous marijuana use. Further, on days of simultaneous use, participants reported being high for 10% more hours (but did not experience more negative consequences) compared to marijuana use days without simultaneous alcohol use. On days with marijuana use, each additional hour high was linked to 14% more negative marijuana consequences, and simultaneous use carried greater odds of feeling clumsy or dizzy.

Researchers note the findings may not generalize to all populations, given the sample was higher-risk substance-using young adults. The findings provide the strongest evidence to date that simultaneous use is high risk and should be the focus of ongoing education and prevention efforts—including messaging that those who use alcohol and marijuana simultaneously would particularly benefit from monitoring and limiting the amounts consumed.

Dailly-level simultaneous alcohol and marijuana use and associations with alcohol use, marijuana use, and negative consequences in a young adult community sample. A. Fairlie, B. Calhoun, S. Graupensperger, M. Patrick, C. Lee. (pp xxx)

ACER-22-5557-R1

Newswise — It’s a therapy that’s commonly used to help overcome addiction or substance abuse, but motivational interviewing could improve the health and wellbeing of frontline aged care workers, according to new research by the University of South Australia.

The study found that motivational interviewing can empower disengaged aged care workers to prioritise and take control of their mental and physical health, thereby boosting workplace wellbeing.

Working with an accredited exercise physiologist, frontline aged care workers received counselling and education on personal goal setting, actions, and coping, as well as measures of activity intensity.

After three months, their perceived autonomy in exercise increased by nearly 9% which is a good predictor of future behaviour. Additionally, their fitness improved as indicated by a small increase in their six-minute walk distance at the nine month follow up.

Participants also reported positive changes in other health behaviours such as eating better, seeking more help from health professionals for the management of health conditions, and not being so hard on themselves when they slipped up.

Workplace interventions that can improve working conditions and wellbeing are in high demand in Australia’s troubled aged care sector where understaffing, low pay, high staff turnover, lack of opportunities for upskilling, high physical and emotional job demands and low job control for employees continue to mar the industry.

Aged care is one of Australia’s largest service industries with about 366,000 paid workers.

UniSA researcher and exercise physiologist, Dr Merilyn Lock, says motivational therapy could be an effective intervention to address systemic apathy among frontline aged care workers.

“There’s no doubt that Australia’s aged care sector is under pressure. We have an ageing population, complex care requirements, funding issues, and a shortage of qualified and skilled aged care workers,” Dr Lock says.

“Supporting the physical and mental wellbeing of frontline aged care workers is imperative, as quality care is inextricably linked with quality jobs.

“Motivational interviewing is a personalised and empathetic counselling technique that empowers a person to explore and resolve ambivalence. It works by assuming that any change is better than nothing, and because it is goal-directed it encourages people to identify, recognise and sustain positive change.

“The workplace is a convenient means to target the health behaviour of large numbers of employees. By engaging and motivating frontline aged care workers to make positive changes to their health, we’re hoping to better support the aged care workforce and subsequently people in aged care.”

While more research is needed to address the uptake of such interventions at organisation levels, the study is a promising initiative to help aged care workers to take control of their own health and wellbeing.

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EMBARGOED FOR USE UNTIL:

12:01 a.m. (EDT) on Sept. 14, 2023

 

Newswise — Overdose deaths from fentanyl laced stimulants have risen 50-fold since 2010

 

The trend marks the fourth wave in the US overdose crisis, which began with prescription opioid deaths in the early 2000s and has since continued with other drugs

New UCLA-led research has found that the proportion of US overdose deaths involving both fentanyl and stimulants has increased more than 50-fold since 2010, from 0.6% (235 deaths) in 2010 to 32.3% (34,429 deaths) in 2021. 

By 2021, stimulants such as cocaine and methamphetamine had become the most common drug class found in fentanyl-involved overdoses in every US state.  This rise in fentanyl/stimulant fatalities constitutes the ‘fourth wave’ in the US’s long-running opioid overdose crisis –the death toll of which continues to rise precipitously. 

“We’re now seeing that the use of fentanyl together with stimulants is rapidly becoming the dominant force in the US overdose crisis,” said lead author Joseph Friedman, an addition researcher at the David Geffen School of Medicine at UCLA. “Fentanyl has ushered in a polysubstance overdose crisis, meaning that people are mixing fentanyl with other drugs, like stimulants, but also countless other synthetic substances. This poses many health risks and new challenges for healthcare providers. We have data and medical expertise about treating opioid use disorders, but comparatively little experience with the combination of opioids and stimulants together, or opioids mixed with other drugs. This makes it hard to stabilize people medically who are withdrawing from polysubstance use.”

The findings will be published in the peer-reviewed journal Addiction.

The analysis illustrates how the US opioid crisis began with an increase in deaths from prescription opioids (wave 1) in the early 2000s and heroin (wave 2) in 2010.  Around 2013, an increase in fentanyl overdoses signalled the third wave.  The fourth wave – fentanyl overdoses with stimulants – began in 2015 and continues to grow.

Further complicating matters is that people consuming multiple substances may also be at increased risk of overdose, and many substances being mixed with fentanyl are not responsive to naloxone, the antidote to an opioid overdose.  

The authors also found that fentanyl/stimulant overdose deaths disproportionately affect racial/ethnic minority communities in the US, including Black and African American people and Native American people. For instance, in 2021, the prevalence of stimulant involvement in fentanyl overdose deaths was 73% among 65 to 74-year-old Non-Hispanic Black or African American women living in the western US and 69% among 55 to 65-year-old Black or African American men living in the same area.  The rate among the general US population in 2021 was 49%.

There are also geographical patterns to fentanyl/stimulant use.  In the northeast US, fentanyl tends to be combined with cocaine; in the southern and western US, it appears most commonly with methamphetamine. 

“We suspect this pattern reflects the rising availability of, and preference for, low-cost, high-purity methamphetamine throughout the US, and the fact that the Northeast has a well-entrenched pattern of illicit cocaine use that has so far resisted the complete takeover by methamphetamine seen elsewhere in the country,” Friedman said.

The study was funded by the UCLA Medical Scientist Training Program (National Institute of General Medical Sciences training grant GM008042) and the National Institute on Drug Abuse at the National Institutes of Health (K01DA050771). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Newswise — LOS ANGELES (Sept. 13, 2023) — Heavy alcohol consumption is associated with acute and repeated episodes of pancreatitis, an inflammatory condition that can cause severe abdominal pain and death. According to a new study published in the peer-reviewed journal Gastro Hep Advances, early interventions aimed at eliminating heavy alcohol consumption and addressing frequent concurrent mental health and social factors could reduce the progression of this disease.

The research, led by the study’s senior author, Christie Jeon, ScD, associate professor of Biomedical Sciences, along with Dhiraj Yadav, MD, professor of Medicine at the University of Pittsburgh, emphasizes the need for early intervention strategies to prevent pancreatitis in people who drink heavily.

According to the study, acute pancreatitis is a leading cause of gastrointestinal disease-related hospitalizations in the United States, with a 1%-2% mortality rate. The study’s findings emphasize the significant role of sustained alcohol consumption in patients who were diagnosed with the condition.

“Our research suggests that alcohol, in combination with other factors, makes the pancreas more vulnerable to inflammation,” Jeon said.

The study assessed the drinking patterns of patients who had been using alcohol regularly for an average of around 20 years, and who were hospitalized with acute pancreatitis or recurrent acute pancreatitis. Investigators found that the levels of drinking and the extent of alcohol consumption were considerably high in those patients who consumed, on average, 7-10 drinks per drinking day.

“Our major finding was that there was a significant amount of drinking, both in duration and intensity, in patients diagnosed with acute pancreatitis,” Jeon said.

The study also found that 28% of acute pancreatitis patients and 49% of recurring acute pancreatitis patients had recurrence within less than 12 months. The study suggests that recurring acute pancreatitis patients, due to their alcohol consumption, may be progressing toward chronic pancreatitis, which can result from repeated acute pancreatitis episodes.

“What we’re seeing is that these patients have had long and intense exposure to alcohol,” said Jeon. “In particular, patients with recurring acute pancreatitis show a similar intensity and sustained level of drinking as those patients who have chronic pancreatitis.”

Jeon said the research underscores the need for early intervention in patients who regularly use alcohol, to prevent the progression to chronic pancreatitis.

The study also delves into the complex relationship between alcohol consumption, mental health conditions and negative life events. Many patients with acute pancreatitis or recurring acute pancreatitis reported concurrent mental health disorders, such as depression and anxiety, or negative life circumstances, such as family problems, death or financial strain.

“These findings highlight the need for a comprehensive approach to intervention that addresses both alcohol cessation and underlying mental health issues,” said David Underhill, PhD, chair of the Department of Biomedical Sciences.

Jeon said that a multidisciplinary intervention, which combines counseling, substance addiction medication and holistic care, may help stop disease progression in these types of patients.

“It has to go beyond pancreatitis, beyond alcohol, to really look at the patient as a whole,” she said.

Jeon said that the development of substance-use-focused prevention and management guidelines for acute pancreatitis, which currently do not exist, would be a step in the right direction.

“Our findings highlight the urgency of targeted intervention,” Jeon said. “By addressing alcohol consumption and its interplay with mental health and social factors, clinicians can mitigate the risk of disease progression and better care for patients.”

Further research from Jeon’s team is focused on developing treatments to relieve symptoms and improve quality of life for patients with persistent forms of pancreatitis.

Funding: This study was funded by the Department of Defense award W81XWH-19-1-0888 (PI: Pandol). The sponsor has not taken any part in the conduct of the study and reporting of the findings.

Read more on the Cedars-Sinai Blog: New Research Explores Link Among Diabetes, Pancreatitis and Pancreatic Cancer

Newswise — As the use of medical and recreational marijuana, prescription and non-prescription cannabinoid and other cannabis products increases, scientists are warning consumers of potentially negative medical effects.

Of particular concern is that cannabinoids, whether prescribed or not, may interfere with some prescription medicines, possibly causing serious health consequences for patients.

For that and other reasons, anyone using any type of cannabinoid product should check in with their primary care provider (PCP), said Kent Vrana, the Elliot S. Vesell professor and chair of the Department of Pharmacology at Penn State College of Medicine. Vrana holds a PhD in biochemistry.

“Whether it’s recreational cannabis, prescribed cannabinoid or medical marijuana, it’s important your doctor knows you’re using it,” Vrana said. “A problem in Pennsylvania is that you can get a medical marijuana card without any involvement by your PCP, meaning your doctor may have no idea you’re using if you don’t say something.”

More than 1 million Pennsylvanians have requested and been issued certifications for medical marijuana since it became available at dispensaries across the state in 2018, according to the state Department of Health. And a bill was introduced in the Pennsylvania State Senate in July that, if passed, would legalize marijuana for recreational use among adults.

Evidence suggests that over the counter cannabidiol, or CBD, a compound extracted from the hemp plant that is not impairing ― meaning it doesn’t cause euphoria or a high ― has medicinal properties that could potentially benefit millions of people. Tetrahydrocannabinol (THC) is the main psychoactive compound in marijuana, and it can cause users to experience euphoria. THC is normally contained in recreational marijuana and sometimes is present in CBD products.

Vrana, who has been closely following research developments with CBD, said there are indications it may be helpful in treating a broad range of medical conditions. It has been proven safe and effective in the treatment of seizure disorders and may be useful for treating some cancers.

Science still has much to learn about CBD, however, and while prescription CBD is considered safe when used as directed, other marketed products, such as oils, lotions or gummies, may not be approved by the U.S. Food and Drug Administration (FDA) and can contain potentially harmful substances.

“The trouble is, the whole industry is not regulated by the FDA,” Vrana said. “It’s like the Wild West out there.”

Concerned about unintended drug interactions, Vrana several years ago recruited Paul Kocis, a clinical pharmacist at Penn State Health Milton S. Hershey Medical Center and assistant professor of pharmacology at Penn State College of Medicine, to help research the potential for interactions between the cannabinoids and prescription medications.

After extensive research, Kocis and Vrana teamed up with computer science students from Penn State Harrisburg and launched CANNaabinoid Drug Interaction Review (CANN-DIR.psu.edu), a web-based application intended to increase awareness of possible drug interactions. It is freely accessible and available to anyone who wants to use it, including pharmacists, other health care providers and patients.

The tool, for which a third version was recently released, is available in 11 languages and is currently used in more than 80 countries around the world.

“Our emphasis with this tool is on patient safety,” Kocis said. “There really was no information about how CBD and THC might affect other medications, so we set out to fill a need that was not being met.”

Prescription and non-prescription cannabinoids have been found to have unintended drug interactions with certain antidepressants, anticonvulsants, sedative drugs and narcotics. A common medication that can be affected by a cannabinoid is warfarin, a blood thinner often known as Coumadin.

Marijuana might cause excessive bleeding in patients taking warfarin.

“A lot of people aren’t aware of these potential interactions and that’s why we thought it was important to provide a tool like CANN-DIR, which can be easily used by both medical professionals and patients,” Kocis said. “It’s about enhancing safety for everyone.”

Related content:

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

BYLINE: Myra Wright

Newswise — WINSTON-SALEM, N.C. – Sept. 12, 2023 – Does drinking an excessive amount of alcohol increase the amount of fat deposits in the body? The answer is yes according to new findings from the Multi-Ethnic Study of Atherosclerosis (MESA). Researchers at Wake Forest University School of Medicine found that heavy alcohol consumption is associated with higher levels of ectopic fat, which refers to fat around organs such as the heart, liver and intestines.

The study appears online in the Journal of the American Heart Association.

“Research shows that an excessive amount of alcohol is not good for heart health,” said Richard Kazibwe, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine and lead author of the study. “Pericardial fat, or fat around the heart, is also associated with an increased risk of cardiovascular disease, so we wanted to better understand how alcohol intake might contribute to that risk.”

MESA was initiated in 1999 to study the characteristics of subclinical cardiovascular disease – disorders of the heart or blood vessels detected prior to the appearance of any clinical signs or symptoms – and the risk factors that predict progression to actual cardiovascular disease. The study, funded by the National Heart, Lung and Blood Institute (NHLBI), part of the National Institutes of Health, has included more than 6,500 people of European, African, Hispanic and Asian descent who were between the ages of 45 and 84 and healthy at the time of enrollment.

MESA participants completed a personal-history questionnaire to assess alcohol consumption and were placed in one of the following categories:

• Lifetime abstainers
• Former drinkers
• Light drinkers (less than one alcoholic drink per day)
• Moderate drinkers (one to two alcoholic drinks per day)
• Heavy drinkers (more than two alcoholic drinks a day)
• Binge drinkers (five or more alcoholic drinks in a single day without concurrent light, moderate or heavy alcohol drinking)

Computerized tomography (CT) scans were performed in a subset of participants, which enabled the research team to analyze data on the amount of fat that can build up in certain locations such as around the heart (pericardial fat) and in the liver (hepatic fat).

“The CT scans allow us to see deeper in the body to measure and gain a better understanding of how fat is distributed in the body. Body fat distribution can explain the differences in cardiovascular risk beyond the traditional measure of obesity such as body mass index. For instance, we know that two individuals with similar body mass index can have different cardiovascular risks,” Kazibwe said.

The research team found that heavy alcohol consumption and binge drinking, compared to participants who never had alcohol, was associated with significantly higher pericardial fat. Results were similar for other ectopic depots with the strongest associations for pericardial and hepatic.

“Interestingly, the lowest levels of ectopic fat were seen in people who reported light to moderate intake of alcohol,” Kazibwe said.

When compared with beer and liquor or “hard” spirits, consumption of wine appeared to be less associated with higher pericardial fat, but according to Kazibwe, one possible explanation might be the benefits of polyphenols, beneficial compounds found in wine. 

“Also, there are other characteristics to consider such as diet and exercise,” Kazibwe said. “Wine drinkers might have better access to health care and have healthier lifestyles than non-wine drinkers.”

Overall, the relationship between alcohol consumption and ectopic fat exhibited a J-shaped pattern, a common way to visualize the marked increase in health risks relative to alcohol consumption.

Kazibwe said that multiple previous studies have reported a J-shaped relationship between alcohol consumption and cardiovascular risk where low-moderate alcohol consumption is tied to the lowest cardiovascular risks, while excessive alcohol intake is linked to a higher risk.

“These findings are significant because both excessive alcohol intake and excess ectopic fat accumulation are known risk factors for cardiovascular disease,” Kazibwe said. “It is also important to emphasize that given the well-documented health concerns caused by excessive alcohol consumption, it is important that people are aware of these potential risks.”

Cashell Jaquish, Ph.D., a genetic epidemiologist and program officer at the NHLBI, agreed. “These findings further solidify the relationship between drinking and cardiovascular risk and shed light on specific sub-clinical disease associated with excessive alcohol intake,” said Jaquish, who works with the MESA study. “Additional studies are needed to further clarify the role of ectopic fat distribution in the relationship between alcohol consumption and cardiovascular disease,” she noted.

This study was supported by National Institutes of Health grants R01HL088451, 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01- HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169, and by grants UL1-TR-000040, UL1-TR-001079 and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS).

DISCLAIMER: This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

 

Newswise — The United States is experiencing its highest overall death rates in more than a century, fueled in part by drug overdose mortality. The origins of the current epidemic are due, at least in part, to a 1986 World Health Organization pronouncement that pain treatment is a universal right. As such, cancer pain treatment guidelines were developed, which included the provision of opioids. In 1995, OxyContin was approved for the management of pain, paving the way for widespread prescription of opioids.

Researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators explored trends in drug overdose deaths in the U.S. from 1999 to 2020, based on age, gender, race, urbanization and geography. Results of their original research, published in The American Journal of Medicine, show that drug overdose deaths in the U.S. more than quadrupled from 1999 to 2020, regardless of race, age, geography or urbanization.

From 1999 to 2020, drug overdoses caused 1,013,852 deaths. The rates increased 4.4 times from 6.9 per 100,000 in 1999 to 30 per 100,000 in 2020. In addition, researchers noted that from May 2022 to May 2023, the U.S. experienced its highest number of drug overdose deaths ever recorded in any 12-month period. 

When analyzing subgroups, researchers identified several trends. White and Native Americans or Alaskan Natives have experienced the greatest increase by race. Locations in the Midwest and non-metro areas have been impacted more than other regions.

“Data from our research suggest that clinical and public health interventions should be targeted to populations and regions experiencing the most drug overdose deaths,” said Jennifer Caceres, M.D., senior author and senior associate dean for student affairs and admissions, FAU Schmidt College of Medicine. “Health care providers already have and will continue to play crucial roles in reducing preventable morbidity and mortality from drug overdoses.”

Data from the study show that from 1999 to 2004, Appalachia (primarily West Virginia) and the Southwest (primarily Utah) had the highest death rates from opioids. Over the next five years, mortality rates in these regions increased further and new hotspots appeared in states such as Florida. From 2011 to 2016, hot spots expanded further in Appalachia and the Southwest, but disappeared in Florida, largely due to restrictions on opioid prescriptions. Thereafter, there were marked rises in potentially preventable deaths from heroin.

From 2014 to 2018, fentanyl deaths increased throughout the U.S., although to a lesser extent in the Midwest. Fentanyl has more than 50 times the potency of heroin and 100 times that of morphine. Fentanyl is a synthetic opioid and major cause of drug overdose, especially with the switch from pharmaceutical to illegal forms.   

“We believe that guidelines are necessary for guidance, however, health care providers should make individual clinical decisions for each patient and policy makers for the health of the general public,” said Allison Ferris, M.D., second author, chair of the Department of Medicine, and program director of the internal medicine residency program, FAU Schmidt College of Medicine. “To reduce risks of overdose, addiction care should be integrated into the practice of all health care providers regardless of specialty, and training in this area should be further incorporated into medical education.”

The authors note that one immediate challenge is to encourage all providers and state medical societies to ensure the widest distribution and availability of over-the-counter naloxone, an opioid receptor antagonist that rapidly reverses or blocks the effects of opioids, restores normal respiration and heart rhythm, and reverses the potentially fatal effects of an overdose. Earlier this year, the U.S. Food and Drug Administration approved the first over-the-counter forms of Naloxone as either intramuscular such as the EpiPen® or as a nasal spray.

In addition, the authors stress that more focused interventions will better equip health care providers to adequately assess patients for addiction care and assist those patients in gaining access to such care.

“Public health authorities should collaborate with federal, state and judicial systems to treat patients who have drug use disorders in the same way as patients who have a serious chronic disease to avoid premature death,” said Charles H. Hennekens, M.D., Dr.PH, co-author, first Sir Richard Doll Professor of Medicine, senior academic advisor to the dean, FAU Schmidt College of Medicine, and an adjunct professor of family and community medicine at Baylor College of Medicine. “Death is inevitable, but premature death is not.”

The authors conclude that analytic studies designed in advance to do so are necessary to test the many hypotheses formulated from these descriptive data. These include case-control and cohort studies and, where necessary, to reliably detect the most plausible small-to-moderate effects, large scale randomized trials.

For the study, researchers used data from the U.S. Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER) and Multiple Cause of Death files from the National Center for Health Statistics.

Study co-authors are Tarek Ghaddar, a second-year medical student, FAU Schmidt College of Medicine; Maria Mejia, M.D., an associate professor of family and community medicine, Baylor College of Medicine; Srekar M. Ravi, M.D., an FAU Schmidt College of Medicine graduate and resident in medicine at Mayo Clinic in Phoenix; and Robert S. Levine, M.D., a professor of family and community medicine, Baylor College of Medicine and an affiliate professor of population health and social medicine at FAU-Schmidt College of Medicine.

– FAU –

About the Charles E. Schmidt College of Medicine:

FAU’s Charles E. Schmidt College of Medicine is one of approximately 156 accredited medical schools in the U.S. The college was launched in 2010, when the Florida Board of Governors made a landmark decision authorizing FAU to award the M.D. degree. After receiving approval from the Florida legislature and the governor, it became the 134th allopathic medical school in North America. With more than 70 full and part-time faculty and more than 1,300 affiliate faculty, the college matriculates 64 medical students each year and has been nationally recognized for its innovative curriculum. To further FAU’s commitment to increase much needed medical residency positions in Palm Beach County and to ensure that the region will continue to have an adequate and well-trained physician workforce, the FAU Charles E. Schmidt College of Medicine Consortium for Graduate Medical Education (GME) was formed in fall 2011 with five leading hospitals in Palm Beach County. The Consortium currently has five Accreditation Council for Graduate Medical Education (ACGME) accredited residencies including internal medicine, surgery, emergency medicine, psychiatry, and neurology.

 

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.