Category: From Newswise – Addiction

Newswise — WASHINGTON – A rigorous, comprehensive synthesis of evidence from 62 studies related to the use of oral nicotine pouches by Georgetown University’s Lombardi Comprehensive Cancer Center scientists and colleagues provides a much-needed assessment of how these products could lead to potential harmful consequences if used by young people.

Oral nicotine pouches were first introduced in the U.S. in the past decade and are pre-portioned white granular packets containing nicotine placed between the gums and lips, marketed as tobacco-free, and are sold in various flavors and nicotine strengths.

The findings appeared in Nicotine and Tobacco Research on June 17, 2024.

“Oral nicotine pouches are rapidly increasing in popularity. While they may present a less harmful nicotine alternative for cigarette users, there is considerable concern about them becoming a new form of nicotine dependence, especially in youth who don’t use tobacco or nicotine,” says the study’s corresponding author Nargiz Travis, MSPH, Project Director for the Center for the Assessment of Tobacco Regulations (CAsToR) at Georgetown Lombardi. “As with electronic cigarettes, the wide variety of flavors and aggressive marketing campaigns that we are seeing, especially via social media, have the potential to appeal to youth, providing a new pathway to nicotine dependence.”

The investigator’s analysis was based on 45 academic and 17 industry-funded studies, mostly from the U.S. Sales of the products have been concentrated in Scandinavia and the U.S., mainly because of the established smokeless tobacco market in these regions.

In the U.S., the researchers found, based on nationally representative surveys, that through 2023, oral nicotine pouches were currently used by 1.5% of all youth while lifetime use by young people was under 2.5%. In terms of awareness of the products, between 35% to 42% of U.S. adolescents and young adults have heard of oral nicotine pouches and 9% to 21% of tobacco-naïve (non-tobacco users) youth surveyed were not opposed to trying them. U.S. adult usage estimates varied widely across surveys; in 2023, 0.8-3% of Americans currently used the products while 3-16% used them at some point in time. In view of rising nicotine pouch sales trends in 2024, their use in the U.S. population has likely increased.

The investigators’ findings suggest fewer harmful chemical compounds are present in the pouches and occur at lower levels than in cigarettes and smokeless tobacco, with the exception of formaldehyde. However, an analysis of 37 oral nicotine pouches of different brands, nicotine strengths, and flavors yielded a wide range of total nicotine content from 0.89 to 6.73 milligrams per pouch.

“Because oral nicotine pouches do not contain tobacco leaves, they are often marketed as tobacco-free, but we found that descriptor may confuse the understanding of the source of nicotine and may be associated with the perception that they are not as harmful as other tobacco products,” says Travis. “In the U.S., oral nicotine pouches are currently neither authorized by the FDA for marketing as a modified-risk product nor approved as a cessation product. It is important to know that nicotine is an addictive chemical with harmful health effects, regardless of whether it is synthetic, meaning tobacco-free, or derived from tobacco.

One of the studies included in the authors’ analysis was a U.S. survey of young adults 18-34 years of age, many of whom used cigarettes and e-cigarettes. The survey found that among those who had tried nicotine pouches, curiosity about the product (28%), flavors (26%), and the ability to use in places where other tobacco products are prohibited (26%) were among the main reasons for trying the pouches. The availability of flavors (31%) was the main motive for use in another U.S. sample of adult current nicotine pouch users.

Leading brands of the products are currently owned by major tobacco companies. The authors note that a substantial investment in marketing by the companies suggests that oral nicotine pouches are becoming increasingly important to the tobacco industry.

“As more evidence on oral nicotine patches becomes available, and more importantly, more independent studies become published, it will

be essential to conduct further analyses comparing the findings of industry vs. non-industry sponsored research and critically assess the quality and risk of bias of such studies,” concludes Travis.

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Other authors in addition to Travis include Hayoung Oh, Radhika Ranganathan and David Levy at Georgetown Lombardi Comprehensive Cancer Center. Kenneth Warner is at the University of Michigan; Rafael Meza is at the BC Cancer Research Centre, Vancouver, Canada; Maciej Goniewicz is at Roswell Park Comprehensive Cancer Center, Buffalo, NY; and Jamie Hartmann-Boyce is at the University of Massachusetts Amherst.

This work was supported by National Cancer Institute and Food and Drug Administration grant #U54CA229974.

Goniewicz received a research grant from Pfizer and served as a member of the scientific advisory board to Johnson & Johnson. The other authors declared no conflicts of interest related to the study.

About Georgetown University’s Lombardi Comprehensive Cancer Center

Georgetown’s Lombardi Comprehensive Cancer Center is designated by the National Cancer Institute (NCI) as a comprehensive cancer center. A part of Georgetown University Medical Center, Georgetown Lombardi is the only comprehensive cancer center in the Washington D.C. area. It serves as the research engine for MedStar Health, Georgetown University’s clinical partner. Georgetown Lombardi is also an NCI recognized consortium with John Theurer Cancer Center/Hackensack Meridian Health in Bergen County, New Jersey. The consortium reflects an integrated cancer research enterprise with scientists and physician-researchers from both locations. Georgetown Lombardi seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic, translational and clinical research, patient care, community education and outreach to service communities throughout the Washington region, while its consortium member John Theurer Cancer Center/Hackensack Meridian Health serves communities in northern New Jersey. Georgetown Lombardi is a member of the NCI Community Oncology Research Program (UG1CA239758). Georgetown Lombardi is supported in part by a National Cancer Institute Cancer Center Support Grant (P30CA051008). Connect with Georgetown Lombardi on Facebook (Facebook.com/GeorgetownLombardi) and Twitter (@LombardiCancer).

About Georgetown University Medical Center

Georgetown University Medical Center (GUMC) is an internationally recognized academic health and science center with a four-part mission of research, teaching, service and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.  Connect with GUMC on Facebook  (Facebook.com/GUMCUpdate) and Twitter (@gumedcenter).

Newswise — Two issues have surged in awareness across America in recent years: the toll of firearm injuries and deaths, and the impact of mental health conditions. 

These two issues intersect in multiple ways – and a growing number of people are directly or indirectly affected by one or both of them. 

That’s why it’s important for you to know some key things about the risk of firearm-related incidents involving people with mental health conditions, and take steps to reduce that risk, say three experts from Michigan Medicine, the University of Michigan’s academic medical center, and the Institute for Firearm Injury Prevention who have training and experience in both fields. 

The group discusses these risks and risk-reduction steps in depth during a recent livestream. 

Below are some key takeaways from that chat with Victor Hong, M.D., director of Psychiatric Emergency Services at U-M Health, child psychologist and firearm injury prevention researcher Cynthia Ewell Foster, Ph.D., and Mark Ilgen, Ph.D., director of U-M Addiction Treatment Services.

1. Suicide is the top concern when it comes to mental health and firearms – but not the only one

More than half of all firearm deaths in the United States are suicides, and firearms are involved in half of all suicide deaths. 

Not all people who die by suicide have a formal mental health diagnosis, so it’s important for everyone to know the warning signs of suicide and what to do if someone they know is showing some or all of these signs. 

There are some warning signs specific to children and teens too.

These signs include worsening or severe depression symptoms, expressing hopelessness or feelings of being a burden, extreme mood swings, an increase in use of drugs and alcohol, taking risks, seeming to be out of touch with reality, as well as speaking, writing or posting on social media about wanting to die, “unalive” themselves, or not live any longer.

2. Easy access to firearms increases risk 

Being able to get access to a loaded handgun or long gun – their own or someone else’s – greatly increases the risk of suicide death for people experiencing a mental health crisis or suicidal thoughts and impulses. 

Why?

“There’s a speed and irreversibility of firearm usage in a suicide attempt that is very unique,” said Hong, who leads a team that offers 24/7/365 care for psychiatric emergencies of all kinds. 

“When somebody is in a mental health crisis and it’s clear that those imminent warning signs of suicide are there, firearms at the very least need to be secured in some fashion.” 

Hong’s team members screen nearly every patient seeking emergency mental health care at U-M Health for firearm access.

If there are firearms in their home, those should be locked with a gun lock or in a gun safe, with ammunition stored elsewhere. 

Many police stations, sheriff’s offices and other locations make gun locks available for free; the Project Childsafe website is one way to find local agencies that provide them.

Even better: temporarily remove firearms from all the places a person in crisis can access, and secure them in another location, whether that’s a gun shop, a law enforcement agency or the home of a trusted person who will keep them locked with ammunition stored separately.   

Firearm owners should also keep their weapons secured if a child or teen might have access to them, to prevent needless tragedy including suicide and accidental or intentional shootings. 

Michigan law now requires this.

“Everybody has a role to play in suicide prevention in this country, and one of the most important things we can all do is to be sure that we’re storing our firearms safely at all times and controlling who has access to them,” said Ewell Foster. 

“If you look at kids in this country who have died by suicide, and you look at where they’re getting those firearms, they are getting them from people who love them. They’re getting them from their house, their parents, their grandparents, their aunts and uncles.”

Ilgen likens suicide risk to a graph with a curve that rises slowly or sharply to a peak – with the top of the curve being the moment where they are at highest risk of harming themselves. 

“If someone enters that upward slope at a time where they have very easy access to something that’s very lethal, that’s when things get very concerning quickly,” he said.

“Even a step that isn’t foolproof but can slow access can buy someone a few minutes or hours before they might act on a suicidal thought. That can make all the difference in helping to keep someone safe and getting someone through that curve” and help them avoid death or injury. 

3. Help is always available for a person in crisis

The 988 Suicide and Crisis Lifeline can be reached by dialing 988 from any phone, by texting 988 from any mobile phone, or using the webchat function at 988lifeline.org. 

It offers live help around the clock, every day of the year and can connect the person in crisis, or a person assisting the person in crisis, to local services, too. 

The 988 service includes specialized options for veterans, members of the LGBTQ+ community, people who speak Spanish and other languages, and people who are Deaf or hard of hearing.

No matter whether someone reaches out to 988 or to a trusted family member, friend, teacher, coach, clergy member or health care provider, it’s important for everyone to know that there are effective treatments available for mental health conditions of all kinds, and that there is hope.

4. Some groups of people have an elevated risk of firearm suicide

Middle-aged and older men account for most of the suicide deaths in Michigan and other states, and most of these deaths are due to firearms. 

Native Americans, and Black youth, as well as young people living in rural areas, also have higher rates of firearm suicide than other groups, says Ewell Foster. 

In order to reach some of those groups with messages about storing firearms safely and seeking help when they need it in a crisis, Ewell Foster and her colleagues have been working to understand which messengers will be most effective for different groups, and how to tailor messages to them.

Ilgen, who is also affiliated with the VA Ann Arbor Healthcare System, notes that veterans are also at higher risk of firearm suicide. 

In fact, 70% of all veteran suicide deaths are firearm-related. 

The VA has created multiple programs to try to prevent these tragedies among veterans who receive care from VA clinics and hospitals. 

5. Drug and alcohol problems raise firearm injury and death risk

While many people may think of depression, bipolar disorder and post traumatic stress disorder as the mental health conditions most closely linked to a risk of firearm suicide, Ilgen notes that an increasing amount of evidence points to high risk among people who have substance use issues and use drugs or alcohol heavily. 

“Substance use disorders are impairing – making your judgment a little cloudy – and they’re stigmatized, and that can make someone more likely to be suicidal,” he said. 

“If they’re progressing rapidly from not thinking at all about suicide to engaging in a suicidal behavior, that that’s more likely to occur if they’re using substances and more risky if they have access to a particularly lethal means like a firearm.”

He also worries that one of the approaches used in some addiction treatment programs – having the patient’s loved ones tell them in a formal session what the patient’s addiction has done to harm those around them – may be counterproductive or even dangerous. 

Doing this could increase the chance the patient feels like a burden to others, and turns toward suicide.

6. Risk factors for suicide and firearm violence toward others can be similar 

When you hear about a violent event on the news that involves firearms used against other people, you might assume that the shooter has a mental illness. 

But Hong notes that it’s important to know that people with serious mental illnesses are more likely to be victims of firearm violence than perpetrators. 

That said, some of the same risk factors and warning signs that someone may be at high risk of turning a firearm on themselves also could signal a risk that they will use a firearm against someone else. 

That’s why Hong and his psychiatric emergency team screen for those risk factors, as well as firearm access, when a patient comes to them in crisis. 

Murder-suicides, in which a person kills a loved one immediately before killing themselves, often happen because someone has decided they don’t want to continue living and that they want to take loved ones or others with them, Hong says. 

7. “Red Flag” laws can help reduce risk in extreme situations 

What can someone do if they’re very concerned that a loved one, friend or co-worker who owns firearms could be at high risk of hurting themselves or others, but that person does not see the risk or want to secure their firearms voluntarily?

In a growing number of states, including Michigan, public safety and court officials can be asked to determine next steps under an Extreme Risk Protection Order law, also known as ERPO or “red flag” law. 

Michigan’s ERPO law went into effect in February 2024. 

The U-M Institute for Firearm Injury Prevention has a free online toolkit that explains the law and how individuals can use it to petition a judge to authorize law enforcement to remove firearms from a person’s possession in an orderly way. 

It’s located at firearminjury.umich.edu/erpo-toolkit.

“This is an evidence-based policy intervention that can prevent a host of adverse outcomes with firearms,” saidEwell Foster, who has spent time with family members of those who have suffered a tragic loss of a loved one from a firearm injury that could have been prevented. 

Prior to Michigan’s ERPO law, she said, “I’ve had moms of young adult males who have a high risk of suicide say, ‘I’m so worried, I’ve asked him to get rid of his firearm and I feel like there’s nothing I can do.’ When people are at risk their loved ones are worried about them and ERPO is another tool in our toolkit to try to support someone who’s at risk.” 

She notes that U-M researcher April Zeoli, Ph.D., policy core director at the institute and associate professor in of the School of Public Health, is one of the nation’s top experts on studying what happens in states that enact ERPO laws, and helped inform the policy process that led to Michigan’s law. 

“It’s really important for folks to know that there are legal checks and balances as part of this law, and that it’s not like someone is going to show up at a person’s house and take away their firearms,” immediately after someone files an ERPO petition, she explains. 

Hong added, “This is not an effort to remove firearms from law-abiding citizens who are low-risk, minding their own business. 

This is really for people for whom there are numerous red flags and risk factors of potential harm to self and others.” 

He also notes that removal of firearms by law enforcement only takes place after a judge rules based on the evidence, and that the removal is temporary.

8. Everyone can make a difference

Ewell Foster likens this moment, when awareness of firearm injury and mental health are both rising, to a time decades ago when there was rising awareness and action around drunk driving. 

“Our society has gotten comfortable saying to one another, ‘Hey, I think you’ve had too much to drink, I’m going to take your car keys and how about I run you home,’ and that’s a socially acceptable thing to do now in this country,” she said. 

“I think we need to work on getting there around mental health and normalizing saying things like, ‘I really care about you, I’ve noticed these changes in you, I’m even wondering if you’re thinking about suicide. How can I help you?’”

“So much of what we’ve learned about how to protect people is about these caring behaviors, and actively working to be sure they feel like they have belonging and connectedness,” she said. 

“I want people to feel empowered that they can reach out and ask, and they can make sure their firearms are stored safely.”

BYLINE: Mark Reynolds

Newswise — Opioid overdoses for pregnant people are at an all-time high in the United States, even as overall numbers are improving. Attention deficit hyperactivity disorder (ADHD) is highly correlated with substance use disorders, yet treatment protocols to help expecting parents manage opioid use disorders and ADHD together are essentially nonexistent.

New research from Washington University School of Medicine in St. Louis may help change that. A study published in Nature Mental Health indicates that patients with opioid use disorders and ADHD who remain on their ADHD medications during their pregnancies are far more likely to adhere to treatment for opioid use, and far less likely to overdose, than are patients who stop taking ADHD medications.

This research is a step toward developing urgently needed resources and treatment guidelines, said Kevin Xu, MD, an assistant professor of psychiatry and the study’s first author. “We have really never seen such rates of overdose among reproductive-age and pregnant people,” Xu said.

According to data from the National Institutes of Health (NIH), rates of overdose deaths doubled among pregnant and postpartum people in recent years (rising to 6.1 deaths per 100,00 in 2021, from 3.1 deaths per 100,000 in 2018). Opioid overdose accounts for about 10% of all pregnancy-related deaths. Despite research indicating that nearly one in four people diagnosed with ADHD also has a substance use disorder, there is little research available to physicians or their patients to guide how they can safely manage both conditions during pregnancy.

That lack of research struck psychiatry resident Tiffani Berkel, MD, PhD, as she was trying to advise patients navigating their pregnancies, which led her to approach Xu and propose this study.

“It’s very common for pregnant patients to ask their doctors, ‘Is this medication safe?’” Berkel said. “The physicians have to say, ‘We don’t know.’ That’s not very reassuring to a pregnant person. They have to do this risk-benefit analysis themselves.”

By examining de-identified prescription and Medicaid databases, Berkel, Xu and their co-authors focused on 168 pregnant patients who were receiving methadone or buprenorphine for opioid use disorder treatment and taking medications for ADHD. They analyzed how long the patients maintained their opioid use disorder treatments and how often they required emergency room care related to opioid use.

Because methadone clinics frequently require patients to stop taking any ADHD medications, there were not enough patients in that group to do a proper analysis. For patients treated with buprenorphine, the differences between patients who remained on their ADHD medications during their pregnancies and those who discontinued were striking: Those who continued with their ADHD medications stayed roughly two months longer on buprenorphine than did patients no longer taking ADHD medications. In line with that result, the researchers found there were fewer emergency room visits related to substance use disorder among patients taking ADHD medications: 41% of patients who continued their ADHD treatments went to the ER compared with 54% of those who stopped.

The reasons for the difference will need further investigation, but Berkel said one potential explanation is that ADHD drugs help control impulsivity and are therefore likely to improve patients’ ability to manage their substance use disorder treatments – with the additional benefit of improved attendance for regular pregnancy checkups.

Co-author Jeannie Kelly, MD, an associate professor of obstetrics & gynecology in the Division of Maternal-Fetal Medicine & Ultrasound, said that research like this serves a real-world medical need to better understand the potential consequences of discontinuing ADHD treatments for patients with substance use disorders. Kelly, Xu and Berkel treat patients at Barnes-Jewish Hospital.

“Treatment of ADHD is a huge knowledge gap in obstetrics and even more so in patients with substance use disorder,” Kelly said. “In obstetrics, a knowledge gap frequently leads to reluctance to treat because of unknown risks to the fetus. However, it’s also really important to discuss the risks of not treating, because untreated disease also can have huge implications for mom’s and baby’s health.”

BYLINE: Andrea Siedsma

Newswise — Opioids are a broad group of effective pain-relieving medicines that can become highly addictive in some individuals. According to government sources, nearly 40 million people are addicted to illicit drugs worldwide. In 2017, the U.S. Department of Health and Human Services declared the opioid crisis a national public health emergency. To combat the opioid epidemic, researchers at University of California San Diego School of Medicine will develop an AI model that will more accurately predict opioid addiction in high-risk patients.

The project is funded through a three-year contract with Wellcome Leap as part of a $50 million groundbreaking initiative, called Untangling Addiction. The goal is to revolutionize how we understand opioid addiction and leverage innovative tools, such as artificial intelligence and predictive modeling, to intervene. UC San Diego School of Medicine was one of 14 locations worldwide to receive the funding.

“Controlled opioids in the health care setting are still an important part of adequate pain control and used for standard care. However, it is critical to know who is receiving these drugs and the risk it carries with some patients,” said Rodney Gabriel, MD, lead researcher for the project, chief of perioperative informatics in the Department of Anesthesiology at UC San Diego School of Medicine and clinical director of anesthesiology at UC San Diego Health.

“The AI model will help to identify who is most at risk for an opioid addiction and implement useful resources to help manage their opioid regimen. This way, we can better manage pain in this patient population and also avoid the potentially dangerous downstream consequences of addiction.”

The model will use generative artificial intelligence (GenAI), which can produce various types of content. It offers a more holistic approach, which can help with understanding and predicting multiple aspects of a patient’s prior and future behaviors.

“GenAI provides more sophisticated ways to predict multiple outcomes based on patterns discovered from large patient datasets,” Gabriel said. “We want to better predict risk of addiction the moment a patient is given an opioid prescription to the moment they would start to become addicted.”

Researchers will develop electronic health record (EHR) foundation models in a secure platform, which will leverage large multi-institutional datasets to incorporate genomic, social determinants of health, clinical, procedural and demographic data to predict the development of opioid use disorder and related outcomes among any patient initially prescribed an opioid.

“Anesthesiologists have access to a variety of secure data, which we review to safely get a patient through surgery. Dr. Gabriel’s research focus is how AI-assisted knowledge of a patient’s risks can optimize their overall care, and in this particular instance, decrease the chances of addiction,” said Ruth Waterman, MD, chair of the Department of Anesthesiology at UC San Diego School of Medicine and anesthesiologist at UC San Diego Health.

“What will be gained from this project will be translatable to many other areas of a patient’s health care journey, resulting in better outcomes and care.”

When the predictive tool is ready to be tested in clinical settings, Gabriel and his team will partner with the Joan & Irwin Jacobs Center for Health Innovation at UC San Diego Health (JCHI), which provides a unique environment for integrating AI approaches into clinical care.

“JCHI will be an indispensable resource for computational, technical and collaborative needs,” said Gabriel. “Our project aligns with the vision of JCHI, in which we leverage AI to make impactful and significant changes for the future of medicine.”

For Karandeep Singh, MD, who was named the inaugural chief health AI officer at UC San Diego Health, real-world evaluations of GenAI’s potential are critical.

“Generative AI has the potential to help us better understand people’s risk, but this idea hasn’t really been put to the test in most areas of medicine,” said Singh. “This project will be key towards helping us understand the potential of generative AI in identifying opioid risk.”

The ultimate goal of the project is to develop a commercially available genomic and microbiome panel that clinicians can use to easily assess opioid addiction, as well as to develop automated approaches using AI to integrate into EHR systems.

“This will allow us to make real-time predictions of risk throughout a patient’s entirety of care and lead the way in the prevention of opioid addiction,” said Gabriel.

# # #

BYLINE: Enrique Rivero

Newswise — A clinical trial on a two-drug therapy for methamphetamine use disorder reduced use of the highly addictive drug for up to 12 weeks after initiation of treatment, UCLA-led research suggests.

Participants in the ADAPT-2 clinical trial who received a combination of injectable naltrexone plus extended-release oral bupropion (NTX+BUPN) had a 27% increase in methamphetamine-negative urine tests, indicating reduced usage. By contrast, the placebo group had an 11% increase in negative tests.

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

“These findings have important implications for pharmacological treatment for methamphetamine use disorder. There is no FDA-approved medication for it, yet methamphetamine-involved overdoses have greatly increased over the past decade,” said Dr. Michael Li, assistant professor-in-residence of family medicine at the David Geffen School of Medicine at UCLA and the study’s lead author.

Methamphetamine use has continued growing over the years around the world, increasing from 33 million people in 2010 to 34 million in 2020. Overdose deaths from the drug have jumped fivefold in the US from 2012 to 2018, and are followed by Canada and Australia in increases.

To curb the ongoing crisis, the National Institute on Drug Abuse (NIDA) Clinical Trials Network has supported various trials, including the ADAPT-2 trial, to test the effects of different pharmacological treatments for methamphetamine use disorder. ADAPT-2 was carried out from May 23, 2017 to July 25, 2019 across the eight trial sites that included UCLA. It included 403 participants, with 109 assigned to the drug combo group and the rest to the placebo group in the first stage.

The latest findings are the second stage of the multi-site trial. The earlier stage had demonstrated that the two-drug combination worked at six weeks, but the unanswered question was whether the intervention remained efficacious over a longer period.

In the second stage, the researchers conducted urine tests on the participants at weeks seven and 12, and again post-treatment at weeks 13 and 16 comparing the group on NTX+BUPN with the placebo group.

There is a need for further research to determine whether the drug treatment effect lasts longer than 12 weeks and yields further methamphetamine use reductions, the researchers write.

“Prior stimulant use disorder treatment trials suggest that change in use is gradual (consistent with our findings), unlikely to result in sustained abstinence in a typical 12-week trial, and dependent on treatment duration,” they write. “This warrants future clinical trials to quantify changes in MA use beyond 12 weeks and to identify the optimal duration of treatment with this medication.”

Study co-authors are Brendon Chau, Thomas Belin, and Steven Shoptaw of UCLA, and Thomas Carmody, Manish Jha, Elise Marino, and Dr. Madhukar Trivedi of the University of Texas.

The study was funded by awards from the National Institute on Drug Abuse of the U.S. National Institutes of Health (UG1DA020024, K01DA051329, UG1DA013035, UG1DA040316, UG1DA013727, and UG1DA015815), the U.S. Department of Health and Human Services under contract numbers HHSN271201500065C (Clinical Coordinating Center, the Emmes Company) and HHSN271201400028C (Data and Statistics Center, the Emmes Company), the U.S. National Institute of Mental Health (K23MH126202) and the O’Donnell Clinical Neuroscience Scholar Award from the University of Texas, Southwestern Medical Center.

Article Citation: doi.org/10.1111/add.16529

BYLINE: Enrique Rivero

EMBARGOED FOR USE UNTIL:

11 A.M. (EDT) ON JUNE 5, 2024

 

Cannabis use common among patients, with most using it to manage a symptom or health condition

Newswise — One in six patients in primary care reported cannabis use, with 35% of those using at levels indicating moderate- to high-risk for cannabis use disorder, new UCLA research finds.

The findings, to be published June 5 in JAMA Network Open, suggest that most patients reported using cannabis for symptom management, despite identifying as recreational users, indicating the need for routine cannabis screening.   Currently few healthcare systems offer this screening in primary care settings.

“Patients may not tell their primary care providers about their cannabis use, and their doctors may not ask about it,” said lead author Dr. Lillian Gelberg, professor of family medicine at the David Geffen School of Medicine at UCLA and of health policy and management at the UCLA Fielding School of Public Health  “Not asking patients about their cannabis use results in a missed opportunity for opening up doctor-patient communication regarding use of cannabis generally and for management of their symptoms. “

Thirty-eight states, three US territories and the District of Columbia allow cannabis for medical use, and 24 of these states also permit recreational use. Stigma over cannabis use has fallen likely due to these legal moves. While there has been an increased perception that its use is risk free, cannabis potency has increased.

The U.S. Preventive Services Task Force recommended in 2020 that primary care physicians screen their adult patients for use of cannabis and other substances. The following year the investigators implemented the UCLA universal electronic health record-based, self-administered survey on cannabis use and medical cannabis use. Patients complete this survey as pre-visit screening prior to their primary care visits as sent to them via the Epic patient portal.

The researchers used patients’ de-identified electronic health records at UCLA collected from January 2021 to May 2023 to determine the prevalence, correlates and reasons for current cannabis use. The UCLA Health system is one of the few to ask patients to voluntarily complete cannabis use surveys during pre-appointment check-ins. The survey used the WHO Alcohol Substance Involvement Screening Test (ASSIST) to assess cannabis use.

Nearly 176,000 patients completed surveys. Of those, nearly 30,000 (17%) reported cannabis use among whom 35% had results suggesting moderate- to high-risk for a cannabis use disorder, defined as a score of 8 or higher on the screening survey. Among users, 40% used cannabis once or twice in the previous three months, 17% used monthly, 25% used weekly and 19% used it daily or almost daily.

Other findings included:

• Cannabis use was lowest among people living in the most disadvantaged neighborhoods (14%), yet the risk for disordered use was highest among this group
• Inhaled modes of cannabis use were as common as ingestion (65.0% and 64.7%), including 29% who vaped
• 47% used cannabis for medical reasons
• 76% used it to manage symptoms such as mental health symptoms or stress (56%), sleep (56%), and pain (37%). Further, most patients who reported using cannabis only for recreational reasons had also used it at some point to manage a symptom.

The study has some limitations. The findings are based on patients’ self-reported use and though cannabis is legal in California, some patients may still have been reluctant to disclose using it. Much of the data were from screenings taken during the COVID-19 lockdown, during which cannabis use may have been higher than it might have been otherwise. In addition, the findings may not be applicable to other health systems, particularly in states where cannabis use is still illegal.

However, “given the high rates of cannabis use and medical cannabis use that we found in this large urban healthcare system, it is essential that healthcare systems implement routine screening of all primary care patients,” the researchers write.  “Integrating screening efforts to include information regarding cannabis use for symptom management could help enhance the identification and documentation of medical cannabis usage, particularly in the healthcare context.” 

Study co-authors are Dana Beck, PhD, MSN; Julia Koerber, MPH; Whitney N. Akabike, PMP, MSPH; Lawrence Dardick, MD; Clara Lin, MD; Steve Shoptaw, PhD; and Marjan Javanbakht, MPH, PhD.

The study was funded by the University of California Tobacco-Related Disease Research Program (grant #T29IR0277) and the National Institutes of Health National Center for Advancing Translational Science (NCATS) UCLA CTSI (grant #UL1TR001881). 

Article: [citation] doi:10.1001/jamanetworkopen.2024.14809

Newswise — Physical and sexual abuse, having parents who misuse substances, and witnessing violent crime are tragic events that don’t remain locked in a single point in time. Rather, they are termed adverse childhood experiences (ACEs) and 64 percent of American adults who participated in a recent survey reported experiencing at least one ACE prior to turning 18 years old. 

The wake of these events can extend into adulthood and include harmful behaviors such as self-medicating—which one new study found is akin to adding fuel to an already burning fire.  

This new research, published in Nature Human Behavior, showed that individuals exposed to ACEs are at increased risk of developing mood, anxiety, and substance use disorders. In part, the substance use disorder risk is related to the use of alcohol or drugs to self-medicate mood and anxiety disorders. 

Henry Kranzler, MD, a professor of Psychiatry and the director of the Center for Studies of Addiction in the Perelman School of Medicine at the University of Pennsylvania, co-authored the work. He and his colleagues found that people with these mental health conditions reported experiencing more ACEs and lacking protective factors, such as close family connections, that can mitigate their harms. 

However, according to Kranzler, there are multiple entry points. “These findings suggest that multiple pathways lead to mental health conditions after exposure to childhood adversity,” Kranzler said.  

Prevalence of adverse childhood events   

The axiom “kids are resilient” continues to be tested, and sometimes broken, as the world continues to adapt to the impact of remote learning, stunted social-emotional development, and a spectrum of issues weighing on children during the past few years.   

That spectrum includes the impact of ACEs on children across the country. According to the Centers for Disease Control and Prevention, three in four high school students reported experiencing at least one ACE during the pandemic and were more likely to report poor mental health or suicidal behavior.  

Other research has shown that adverse childhood experiences can influence negative behavior into adulthood, as well as detailed the significant economic impact of ACEs. One recent study put the national economic burden of ACEs-related adult health conditions at $14.1 trillion annually ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years), or $88,000 per affected adult annually and $2.4 million over their lifetime. 

Finding the fire before it spreads 

The group led by Kranzler examined associations among ACEs, mood or anxiety disorders, and substance dependence in 12,668 individuals—42.5 percent Black and 42.1 percent white) and compared two primary hypotheses: self-medication (using substances to cope with trauma) and substance-induced psychiatric disorders (mental health issues caused by substance use). Stronger support was found for the self-medication hypothesis, suggesting that interventions focusing on coping skills and emotional resilience may help reduce the risk of future mental health issues in children exposed to ACEs. 

“Earlier intervention is key,” added Rachel Kember, MSc, PhD, an assistant professor of Psychiatry and study co-author. “The findings provide a better understanding of how it may be best to intervene based on an individual’s specific needs.” 

Genetic factors also play a role, with some individuals having a higher genetic predisposition for developing substance use, mood, or anxiety disorders. The interaction between genetic risk and childhood adversity influences the development of mental health disorders, highlighting the importance of understanding different pathways and designing early interventions to promote emotional regulation and coping skills. 

“Given these results, it’s crucial to prioritize efforts to reduce children’s exposure to early traumatic experiences,” said study co-author Christal Davis, PhD, a postdoctoral fellow at the Corporal Michael J. Crescenz VA Medical Center (VAMC). “This would enhance access to protective factors, which could prevent the need for future mental health interventions.” 

Because there are multiple pathways to the development of mental health conditions following exposure to childhood adversity, regular screening for ACEs and targeted interventions to improve emotional regulation and other coping skills, may help to reduce the harmful impacts of childhood adversity. 

According to Kranzler, greater priority should be placed on both reducing children’s exposure to early traumatic experiences and increasing their access to protective factors. For example, safe, stable, and nurturing relationships, positive friendships and peer networks, and supportive school environments that promote learning and socialization, may help prevent the need for future mental health interventions.  

Though the team expressed caution—more data are necessary to chart firmer next steps due to the novelty of the dataset the team analyzed—it does represent a first step. 

“The findings underscore the need for efforts to prevent or intervene early with individuals who experience adverse childhood events, as they have the potential to prevent or limit the development of a variety of psychiatric disorders, including substance dependence,” Kranzler said.  

“Gene x Environment and Mediation Effects among Adverse Childhood Events, Mood and Anxiety Disorders, and Substance Dependence” was published with colleagues from the Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Quinnipiac University, and Yale University School of Medicine. 

Newswise — New research from the University of South Australia (UniSA) and Curtin University finds that up to 36% of young people leaving foster homes in Australia wind up homeless – compared to less than 10% of the general youth population.

In a paper published in the journal Child Abuse & Neglect, mental health, alcohol, and substance abuse disorders were identified as increasing the risk of homelessness, emphasising the importance of employing systems and resources to improve the outcomes for out-of-home care (OHC)  leavers.

Professor Melissa O’Donnell, Deputy Director of Research at UniSA’s Australian Centre for Child Protection, says more needs to be done to support young people who haven’t had the typical growing-up experience that could otherwise help them with the transition to adulthood and independent living.

“Young people leaving care need help securing stable housing, financial assistance, mentorship support, education and employment services, and life skills training,” Prof O’Donnell says.

“We need to diversify our approach to supporting these groups, with tailored strategies unique to each person and their needs.

“These young people often have minimal social and/or financial support to transition smoothly from OHC to adulthood, which leads to homelessness, substance misuse, and poor mental health.

“Providing transition programs which offer a range of support and resources is vital so that they are tailored to individual needs and goals.”

Curtin University PhD student Fadzai Chikwava says a lack of extended support post-care contributes significantly to homelessness.

“There’s a lack of follow-up on OHC leavers, which is contributing to these poor outcomes,” Chikwava says.

“Evaluation and monitoring systems need to be strengthened as a form of early intervention, and leavers need to be involved in developing support and transition plans to ensure security and success post-care.

“All Australian states have committed to extending leaving care until age 21, however the frequency and extent of this varies depending on the child welfare system in each state.

“Even though leavers have these extra years of support, the quality of this care needs to be improved to ensure young people are provided trauma-informed care and that the support and resources they receive are meeting their needs.”

Notes to editors:

“Trajectories of homelessness and association with mental health and substance use disorders among young people transitioning from out-of-home care in Australia” is authored by Fadzai Chikwava (Curtin University); Reinie Cordier (Northumbria University); Anna Ferrante (Curtin University); Melissa O’Donnell (UniSA) and Eduwin Pakpahan (Northumbria University).

Newswise — A new study by researchers at the Case Western Reserve University School of Medicine reveals that the popular diabetes and weight-loss drugs Wegovy and Ozempic are linked to reduced incidence and recurrence of alcohol abuse or dependence.

The team’s findings, recently published in the journal Nature Communications, may suggest a possible new treatment for excessive alcohol use—including alcohol-use disorder (AUD), a health condition that causes about 178,000 deaths in the United States each year, according to the Centers for Disease Control.

To date, the U.S. Food and Drug Administration (FDA) has approved only three medications to treat AUD.

The active ingredient in Wegovy and Ozempic is semaglutide, which belongs to a class of medications known as glucagon-like peptide-1 receptor agonists (GLP-1). GLP-1 helps regulate blood sugar in type 2 diabetes and reduces appetite.

The researchers examined electronic health records of nearly 84,000 patients with obesity. They found those treated with semaglutide, compared to those treated with other anti-obesity medications, showed a 50% to 56% decrease for both the initiation and re-occurrence of alcohol-use disorder in the year following.

“This is very promising news in that we may have a new therapeutic method to treat AUD,” said Rong Xu, a professor of biomedical informatics at the School of Medicine and the study’s lead researcher.

Xu, also director of the medical school’s Center for AI in Drug Discovery, was joined by medical school co-authors Nathan Berger, the Hanna-Payne Professor of Experimental Medicine, and Pamela Davis, the Arline H. and Curtis F. Garvin Research Professor. Nora D. Volkow, director of the National Institute for Drug Abuse, also co-authored the study.

“We collected real-world evidence in a manner similar to our previous two studies reported earlier this year,” Berger said. “In January we showed that semaglutide is associated with a decrease in suicidal thoughts, and in March, we demonstrated that semaglutide is also associated with a reduction in both new diagnoses and recurrence of cannabis-use disorder.”

Similar findings were replicated when the team examined electronic health records for about 600,000 patients with type 2 diabetes. Again, they found consistent reductions in alcohol-use disorder diagnoses among those treated with semaglutide.

“While the findings are promising and provide preliminary evidence of the potential benefit of semaglutide in AUD in real-world populations,” Davis said, “further randomized clinical trials are needed to support its use clinically for AUD.”