Co-Prescribed Stimulants, Opioids Linked to Higher Opioid Doses

Original post: Newswise - Substance Abuse Co-Prescribed Stimulants, Opioids Linked to Higher Opioid Doses

COLUMBUS, Ohio – The combination of prescribed central nervous system stimulants, such as drugs that relieve ADHD symptoms, with prescribed opioid medications is associated with a pattern of escalating opioid intake, a new study has found. 

The analysis of health insurance claims data from almost 3 million U.S. patients investigated prescribed stimulants’ impact on prescription opioid use over 10 years, looking for origins of the so-called “twin epidemic” of combining the two classes of drugs, which can increase the risk for overdose deaths

“Combining the two drugs is associated with an increase in overdose deaths. This is something we know. But we didn’t know whether stimulant use has a causal role in high use of opioids, so we conducted a big data analysis of how these two patterns interacted over a long period of time,” said senior study author Ping Zhang, associate professor of computer science and engineering and biomedical informatics at The Ohio State University. 

“What we found is that if someone is taking a stimulant and an opioid at the same time, they’re generally taking a high dose of the opioid,” he said. “And if the patient in this study population takes the stimulant before beginning opioid use, they are more likely to have higher doses of subsequent opioids.” 

The study was published Feb. 17 in The Lancet Regional Health – Americas.     

The research team obtained data on 22 million patients with 96 million opioid prescriptions from MarketScan Commercial Claims and Encounters, a large U.S. health insurance database. Researchers established a cohort for this study of 2.9 million patients with an average age of 44 who had at least two independent opioid prescriptions between 2012 and 2021. 

Because these prescriptions included a range of oral formulas – codeine, hydrocodone, methadone, oxycodone, morphine and others – researchers standardized every prescription to morphine milligram equivalents (MME) and calculated each patient’s monthly intake of opioids. The MME computation from electronic health records was previously co-developed by co-senior author Wenyu Song, an instructor at Harvard Medical School. 

First author Seungyeon Lee, a PhD student in Zhang’s lab, used statistical modeling and classified patients into five baseline groups of opioid dosage trajectory over the 10-year study period: very low-dose, low-dose decreasing, low-dose increasing, moderate-dose increasing and high-dose sustained use. 

“Some patients had stable low-dose opioid use, while others had increasing or high dose patterns over time,” Lee said. 

Of the total cohort, 160,243 patients (5.5%) also were prescribed stimulants. The addition of a monthly calculated cumulative number of stimulant prescriptions to the model and statistical analysis showed a shift in the trajectory groups. Characteristics that could serve as risk factors for increasing opioid use also emerged in the data, Lee said. 

Moderate-dose increasing and high-dose groups had an overall higher average MME and a higher proportion of patients with diagnoses of depression, anxiety and attention-deficit/hyperactivity disorder compared to other groups. The low-dose increasing group also had a higher proportion of patients with ADHD compared to the low-dose decreasing group.

The most common diagnoses linked to co-prescription of stimulants and opioids were depression and ADHD or ADHD and chronic pain. 

“This was an important finding, that many patients with ADHD and depression, also experiencing chronic pain, have an opioid prescription,” said Zhang, also a core faculty member in the Translational Data Analytics Institute at Ohio State. “This cohort represents a very realistic health care problem.” 

Even taking those factors into account, the model showed that stimulant use was key to driving up the odds that patients who took both stimulants and opioids would belong to a group of people who increased their doses of opioids.

“Stimulant use before initiating opioids and stimulant co-prescription with opioids are both positively associated with escalating opioid doses compared to other factors,” Lee said.

Analysis of geographic and gender data also offered some clues to opioid use patterns in the United States. Patients in the South and West regions had higher total opioid intakes over the 10-year study period compared to the Northeast and North Central regions, with the highest frequency of opioid prescriptions in the South and higher MMEs per prescription in the West. Males also had higher average daily opioid intakes than females. 

The results linking high opioid doses and stimulant use suggest stimulants may be a driving force behind the emergence of the twin epidemic and offer evidence that regulation of stimulant prescribing may be needed for patients already taking prescription opioids, the researchers said. In addition to the increased risk of overdose death, co-using prescription stimulants and opioids can increase the risk for cardiovascular events and mental health problems, previous research has shown. 

Zhang’s Artificial Intelligence in Medicine Lab focuses primarily on using AI to aid in clinician decision making, and these findings are part of a larger project aimed at development of safer personalized treatment recommendations for people who are prescribed both opioids and stimulants. 

“We want to reduce the risk of opioid- or stimulant-related adverse drug events in real-world practice,” Zhang said. 

This work was funded by the National Institute of General Medical Sciences, the National Institute on Drug Abuse and the National Science Foundation. 

Additional co-authors were David Bates of Harvard Medical School and Richard Urman, chair of anesthesiology in Ohio State’s College of Medicine.

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Contact: Ping Zhang, [email protected]

Written by Emily Caldwell, [email protected]; 614-292-8152

Telehealth May Be Closing the Care Gap for People with Substance Use Disorder in Rural Areas

Original post: Newswise - Substance Abuse Telehealth May Be Closing the Care Gap for People with Substance Use Disorder in Rural Areas
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Rutgers Center for Recovery and Wellbeing Dedicated in Plainfield

Original post: Newswise - Substance Abuse Rutgers Center for Recovery and Wellbeing Dedicated in Plainfield

Each year since 2021, more than 3,000 New Jerseyans – eight people per day on average – have died from unintentional overdoses. For those trying to escape this cycle, inpatient withdrawal management, more commonly referred to as “detox,” is often their best hope.

But in many parts of the state, wait times for a bed could be too long for someone on the edge of sobriety.

The Rutgers Center for Recovery and Wellbeing, in Plainfield, N.J., aims to help fill this need.

“In New Jersey, there is a significant need for new providers to increase access to services, particularly within the inpatient and withdrawal management sector,” said Caitlin Simpson, senior director of addiction services at Rutgers University Behavioral Health Care (UBHC), which partners with RWJBarnabas Health Behavioral Health Services in offering a comprehensive network of mental health services in the state. “The Rutgers Center for Recovery and Wellbeing strives to fill the existing gap in services and the needs of the community.”

Located at the former Muhlenberg Hospital, the four-story, 20,000-square-foot renovated building in the Muhlenberg Medical Arts Complex will be led by Simpson and colleague Josephine Schettino, program director for the Center, who will oversee daily operations.

Once fully operational later this year, the center will offer holistic and integrated diagnostic and clinical care to individuals and their families affected by substance use and co-occurring disorders.

Four levels of care will be available. Twenty of the 44-bed center are designated for individuals in need of medically monitored inpatient withdrawal management services. Clients may choose to transition to one of 24 short-term inpatient beds, with therapy and round-the-clock nursing and monitoring. For those not needing withdrawal management, inpatient care will be the first step.

Following successful completion of inpatient treatment, clients will have the opportunity to transition to the center’s intensive outpatient program, which will offer up to 12 hours of group/individual therapy per week to include medication management and case management services, in addition to traditional outpatient services. For those individuals who live a distance from the Plainfield location, appropriate referrals will be made for outpatient care in their home communities.

The key to the center’s success will be accessibility, said Simpson, adding that the access team will try to schedule clients within 72 hours of contact, if not immediately. 

“When someone calls seeking treatment and is experiencing withdrawal symptoms, they often will require the support and interventions from our medical team, and quick access to treatment can be a world of difference for the overall success of the individual,” Simpson said.

Rutgers purchased the building in May 2020, and a certificate of occupancy was issued by the city in June 2022. Rutgers assumed title of the building in November 2022. Construction of the complex is now complete. The center is currently licensed for outpatient and intensive outpatient care and is awaiting licensure for medically monitored withdrawal management and short-term inpatient treatment.

Rutgers Health University Behavioral Health Care operates substance use disorder treatment services to include intensive outpatient and traditional outpatient programs in New Brunswick, Newark, Cherry Hill and a small program at the Middlesex County Jail. The addition of the Plainfield center will enable Rutgers to provide services to clients across New Jersey with the goal to seamlessly coordinate ongoing care as clinically indicated upon completion of treatment.

“With the Rutgers Center for Recovery and Wellbeing, we will have a great opportunity to support individuals and loved ones on their path to an improved quality of life and long-term recovery,” Simpson said.

Neurosurgery Submits Comment to Senate Judiciary Hearing on Controlled Substances

Original post: Newswise - Substance Abuse Neurosurgery Submits Comment to Senate Judiciary Hearing on Controlled Substances

Washington, DC—Today, the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), and seven other leading medical organizations sent a joint letter to Senate Judiciary Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Dick Durbin (D-Ill.) ahead of the Committee’s hearing titled, The Poisoning of America: Fentanyl, its Analogues, and the Need for Permanent Class Scheduling, scheduled for February 4, 2025. The hearing aims to examine the public health and safety threats posed by illicit fentanyl and its analogues and to evaluate the need for permanent class-wide scheduling of these substances under the Controlled Substances Act (CSA).

“The fentanyl crisis has devastated families and communities across the country. We thank Chairman Grassley and Ranking Member Durbin for the opportunity to provide our clinical perspective on this critical issue and urge Congress to advance a solution before the current authority expires next month,” said Alexander A. Khalessi, MD, MBA, chair of the AANS/CNS Washington Committee. “As physicians and DEA registrants, we are committed to the responsible stewardship of controlled substances, ensuring patients have access to evidence-based pain management. While supporting efforts to combat this public health crisis, we urge Congress to address regulatory barriers that limit access to certain FDA-approved opioid therapies—often the last line of relief for patients with advanced cancer, complex surgical needs, and neurological disorders.”

The letter outlines key clinical considerations related to the permanent scheduling of fentanyl-related substances, focusing on physician compliance with the CSA and the importance of maintaining patient access to necessary treatments. Additionally, the organizations highlighted an unintended consequence of the SUPPORT Act, which has been misinterpreted to prevent pharmacies from dispensing controlled substances for use in intrathecal pain pumps—a critical therapy for patients with severe, chronic pain conditions such as advanced cancer, spinal cord injuries, and neurological disorders. This misinterpretation has created significant logistical barriers, forcing patients and physicians to rely on complex and burdensome workarounds that jeopardize patient safety, disrupt continuity of care, and increase the risk of medication errors and diversion. The letter urges Congress to enact a targeted legislative correction to restore clear, consistent access to these therapies while maintaining appropriate oversight of controlled substances.

In addition to AANS and CNS, the letter was signed by:

  • American Academy of Pain Medicine (AAPM)
  • American Academy of Physical Medicine & Rehabilitation (AAPM&R)
  • American Society of Anesthesiologists (ASA)
  • American Society of Neuroradiology (ASNR)
  • American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine)
  • North American Neuromodulation Society (NANS)
  • North American Spine Society (NASS)

To read the letter, click here.

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The American Association of Neurological Surgeons (AANS), founded in 1931, and the Congress of Neurological Surgeons (CNS), founded in 1951, are the two largest scientific and educational associations for neurosurgical professionals in the world. These groups represent over 10,000 neurosurgeons worldwide. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain, and peripheral nerves. For more information, please visit www.aans.org, www.cns.org, and www.neurosurgery.org.

Scientists Discover How Genetic Risk for Alcoholism Changes Brain Cell Behavior

Original post: Newswise - Substance Abuse Scientists Discover How Genetic Risk for Alcoholism Changes Brain Cell Behavior

Rutgers Health researchers have discovered that brain immune cells from people with a high genetic risk for alcohol use disorder (AUD) behave differently than cells from low-risk people when exposed to alcohol.

Their study in Science Advances could help explain why some people are more susceptible to developing drinking problems and potentially lead to more personalized treatments.

“This is the first study to show how the genetic variations that increase the risk of AUD affect the behavior of some brain cells,” said Zhiping Pang, a professor of neuroscience and cell biology at Robert Wood Johnson Medical School and a resident scientist at the Child Health Institute of New Jersey and a core member at the Rutgers Brain Health Institute.

“We started with a simple model, but as the models get more complex, we’ll learn more about what’s happening in the brain,” said Pang, the senior author of the study. “Hopefully, our discoveries will suggest treatment approaches because we don’t currently have great treatments for AUD.”

According to the 2023 National Survey on Drug Use and Health, nearly 28.9 million people ages 12 and older in the United States struggle with alcohol use disorder. While scientists have known the condition runs in families – with genetic factors accounting for 40% to 60% of risk – the biological mechanisms behind this hereditary component have remained unclear.

The research team took blood samples from two groups of people: those with both high genetic risk for AUD and diagnosed alcohol problems and those with low genetic risk and no alcohol problems. They transformed these blood cells into stem cells and made them develop into a type of brain-based immune cell called microglia.

They then exposed these two groups of cells, one from the people with a high genetic risk for AUD and one from the people with a low risk of AUD, to alcohol levels that mimicked those seen in the blood following alcohol use.

“The microglia with the high genetic risk scores were far more active than the microglia with the low genetic risk scores after the alcohol exposure,” said Xindi Li, lead author of the study, a postdoctoral fellow at the Child Health Institute of New Jersey.

The highly active cells engaged in more “synaptic pruning” – removing connections between neurons in the brain. This increased pruning activity could have significant implications, the researchers said.

“After many years of drinking, people with these genetics may have a greater risk of dementia because the microglia pruned so many more connections,” Li said. “Their overactivity could make neurons less functional.”

The study drew on expertise throughout Rutgers University, involving scientists from multiple labs and departments, including Ronald Hart and Jay Tischfield. This interdisciplinary approach brings together experts in genetics, neuroscience, and addiction research to tackle the complex challenge of understanding how genetic risk factors influence alcohol use disorder at the cellular level. This has been the long-term theme of the Rutgers component of the long-term NIH-funded Collaborative Study on the Genetics of Alcoholism (COGA).

While previous studies have identified genetic variants associated with increased risk, it has been challenging to see how these differences affect brain cell function.

Although this study focused on a single type of brain cell in a flat environment, the team is developing more sophisticated models for their research.

“We’re going from the cell cultures in a 2D situation to the brain organoids,” Pang said. “So we can study something more like a mini brain-structure, to understand how the cells interact with alcohol, and then to see how the genetic risk factors play a role in that response.”

This work could eventually lead to better treatments for alcohol use disorder. The results suggest that if different genetic variations lead to different cell behavior in the brain, people with different genetic signatures may need different treatments, for example targeting the microglia in some people at high risk.

That said, the researchers stressed that much work remains to be done to translate these cellular findings into clinical applications.

Virginia Tech Researchers Ask How Many Attempts It Takes to Quit Substance Abuse

Original post: Newswise - Substance Abuse Virginia Tech Researchers Ask How Many Attempts It Takes to Quit Substance Abuse

BYLINE: Leigh Anne Kelley

Relapse is common when someone is trying to quit, regardless of whether they’re giving up opioids or alcohol or cigarettes.

To better inform treatment, researchers with the Fralin Biomedical Research Institute at VTC’s Addiction Recovery Research Center wanted to better understand how the experience of quitting differed across substances. 

“When we talk about intervention for addiction, we know that we are far from the ideal model of treatment,” said Rafaela Fontes, a research scientist at the institute and first author on the study “Beyond the first try: How many quit attempts are necessary to achieve substance use cessation?”

For the study, “quitting” was based on a yes or no response to a survey question that asked whether participants still used a specific substance. Researchers noted that because substance use is a chronically relapsing disorder, the number of quit attempts reported might not be final, although for all participants across all substances, the average time in abstinence was more than seven years.

The work, scheduled for publication in the Feb. 1 issue of Drug and Alcohol Dependence, found that:

  • Substance use disorder is a chronically relapsing condition that often requires multiple quit attempts before successful abstinence.
  • The number of quit attempts varies by substance, with opioids and pain medication requiring significantly more attempts than all other substances.
  • Hallucinogens are less challenging to quit, requiring fewer attempts.
  • People who meet the criteria of having a more severe or longer history of substance use disorder might need more attempts before achieving abstinence.

“We treat addiction as an acute disorder, even though we know that it is a chronically relapsing condition,” Fontes said. “When we’re talking about addiction, we need to understand that it’s not one size fits all. There are some substances that are harder to quit than others and it’s not equally easy or equally hard for everyone. We cannot use the same strategy for everything because it might not work.”

The findings suggest that early intervention improves success and reduces relapses, according to Allison Tegge, corresponding author on the study and a research associate professor at institute.

“What makes this research stand out is that, not only did we consider the substance, but we asked additional questions to look at the individual experience in context,” Tegge said.

What they did

Researchers recruited study participants from the International Quit & Recovery Registry, a tool created to advance scientific understanding of success in overcoming addiction. Sponsored by the Fralin Biomedical Research Institute, it was developed by Professor Warren Bickel, an addiction expert who died in September. Bickel was an author and principal investigator on the substance use cessation research.

“These findings highlight the relevance of the registry and the work started by Dr. Bickel to understand addiction recovery,” Fontes said. “He was a visionary, and his registry continues to help us gain a deeper and better understanding of recovery trajectories.”

The study ultimately drew its findings from 344 registry participants who completed surveys on the substances they had used, the age of first use, the number of quit attempts, and current substance use. Only participants who reported successful abstinence from at least one substance were included.

Participants were asked which they had used 10 or more times: nicotine, alcohol, cannabis, cocaine, opioids, stimulants, prescription pain relievers, hallucinogens, anesthetics, tranquilizers, inhalants, or “other.” They also were asked about length and severity of use, based on criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

What they found

Participants reported more difficulty quitting pain medication and opioids, substances with high relapse rates and for which short-term treatment effectiveness is low. Both alcohol and stimulants had more quit attempts than cannabis, cocaine, hallucinogens, and nicotine.

Hallucinogens, which have a different clinical profile than other commonly misused substances, required fewer quit attempts. Researchers also found that tranquilizers had a substantially higher number of quit attempts than hallucinogens.

Notably, substances with a higher number of quit attempts were also those that can bring on severe physical symptoms of withdrawal, such as pain, nausea, and anxiety.

The researchers hope their work informs treatment, with a goal of avoiding high rates of relapse and readmission. “This information can help provide the necessary support for someone moving through recovery,” Tegge said.

Why it matters

The research corroborates the chronic nature of substance use disorder and expands on previous research by showing that the number of quit attempts varies depending on the substance.

Additionally, recognizing that it takes multiple attempts, and understanding how some substances may be more challenging to quit than others, is the first step. “If people in recovery knew the average number of attempts it might take to quit a particular drug, rather than see relapse as a failure they might view it as a step on the journey,” Tegge said. “Understanding that relapse is part of recovery can help people stay engaged.”

The challenges of substances’ physiological effects combined with individual circumstances allows treatment providers to create personalized plans. Knowing different factors that affect relapse can help inform interventions. 

In addition to helping inform providers, Fontes also hopes it helps people who are trying to quit. “Maybe they can see that failure is part of the process,” she said, “and think: ‘I just need to keep trying, and eventually I’m going to get there.’”

Authors

  • Rafaela Fontes, research scientist, Fralin Biomedical Research Institute at VTC
  • Allison Tegge, research associate professor, Fralin Biomedical Research Institute at VTC and Department of Basic Science Education, Virginia Tech Carilion School of Medicine
  • Roberta Freitas-Lemos, assistant professor, Fralin Biomedical Research Institute at VTC and Department of Psychology, College of Science
  • Daniel Cabral, postdoctoral associate, Fralin Biomedical Research Institute at VTC
  • Warren Bickel, professor, Fralin Biomedical Research Institute at VTC; Department of Psychology, College of Science; and psychiatry and behavioral medicine, Virginia Tech Carilion School of Medicine

DOI: 10.1016/j.drugalcdep.2024.112525

To participate in this research

  • Complete the questionnaire to see if you qualify to participate in the International Quit & Recovery Registry. Research is conducted online; the registry is worldwide.
  • If you live near Roanoke, consider participating in one of the Addiction Recovery Research Center’s studies. Complete the confidential online screening to see if you are eligible.

Preventing Substance-Use Disorders in Teenagers

Original post: Newswise - Substance Abuse Preventing Substance-Use Disorders in Teenagers

A new randomized controlled trial involving experimental and control groups in Canada has demonstrated the effectiveness of a brief cognitive-behavioral intervention program in reducing substance use disorders (SUDs) in adolescents.

Published yesterday in the American Journal of Psychiatry, the study shows that students who attended two 90-minute workshops in the first year of high school had significantly fewer problems with drugs and alcohol by the time they graduated.

The study was led by Patricia Conrod, a professor in the Department of Psychiatry and Addictology at Université de Montréal and researcher at CHU Sainte-Justine, the university’s affiliated children’s hospital.

3,800 students involved

Conrod and her research team followed 3,800 students in 31 schools in the Greater Montreal area between 2012 and 2017, from Grades 7 to 11. Some of the schools offered the PreVenture program to Grade 7 students deemed at risk based on their results on a questionnaire which assessed four personality traits: impulsivity, thrill-seeking, anxiety sensitivity and hopelessness.

Statistical analyses of the results showed an increase in SUDs in all schools between Grades 7 and 11, and found that 10 per cent of the students met the diagnostic criteria for these disorders by the end of high school. In those who followed the workshops, however, the increase was much less pronounced.

Depending on the year analyzed, the risk of developing SUDs was reduced by 23 to 80 per cent among the students who did the workshops, compared to those who did not.

“With just two 90-minute workshops, the program was able to protect young people against the risk of long-term substance use disorders,” said Conrod, who also holds the Canada Research Chair in Preventive Mental Health and Addiction. “This is particularly promising in the current context of North America’s addiction crisis.”

The PreVenture program is today offered in schools in five Canadian provinces as well as in 12 U.S. states. The interventions help young people explore individual differences in personality traits and the coping strategies they can use to help manage their personality. In the workshops, they also learn about cognitive and behavioural strategies that will help them to channel key personality traits towards long-term goals.

“Individual differences in personality are essential to a healthy and diversified society,” said Conrod. “However, when certain personality traits are mismanaged, some young people will turn to substances to temporarily reduce the stress they feel. By teaching them other, more effective strategies in early adolescence, we can help them better manage everyday challenges.”

“Prevention is one of the most effective and rewarding measures when it comes to drug use among young people,” said Julie Bruneau, an UdeM professor of family medicine who holds the Canada Research Chair in Addiction Medicine and is scientific director of the Quebec arm of the Canadian Institutes of Health Research’s Canadian Research Initiative in Substance Matters.

“This study provides robust, clear Quebec data that can be translated into concrete action,” Bruneau said. “It’s invaluable, and gives us hope that this intervention will soon be available to all young people in Quebec.”

Strategies to Mitigate Xylazine-Involved Fentanyl Overdoses: Lessons from Tijuana, Mexico

Original post: Newswise - Substance Abuse Strategies to Mitigate Xylazine-Involved Fentanyl Overdoses: Lessons from Tijuana, Mexico

A recent study published in the Harm Reduction Journal documents the arrival of xylazine to the San Diego-Tijuana border region, and shows the efforts of local physicians to address this emerging challenge in the nation’s overdose crisis. Xylazine, a veterinary sedative — often referred as “tranq” — has increasingly appeared as an additive in illicit fentanyl, complicating overdose interventions due to its prolonged sedative effects. This has prompted the Biden Administration to label xylazine-fentanyl an emerging threat in the United States. The study, conducted as a collaboration between University of California San Diego researchers and physicians at the Prevencasa community harm reduction clinic in Tijuana, Mexico, discusses how to improve the clinical responses to xylazine-involved fentanyl overdoses, proposing strategies tailored to field settings.

Through case studies of three patients at the Prevencasa clinic, the research highlights unique challenges presented by xylazine-involved fentanyl overdoses, such as prolonged unconsciousness despite naloxone administration and heightened risks of post-overdose confusion and injury. Patients who experience xylazine-involved fentanyl overdose often require careful oxygenation management, including the use of portable oxygen tanks and airway positioning, rather than aggressive naloxone titration.

The clinic’s approach emphasizes harm reduction practices, including using xylazine testing strips to inform patients about drug contents and reduce risks. Strips can be given to participants to directly test their own drug supply before consumption. Additionally, community education and scene safety measures, such as relocating patients to secure environments, are critical components of the response to ensure patients do not place themselves in harmful scenarios. This approach not only enhances immediate overdose management but also empowers patients with knowledge and tools to make safer decisions.

An expert from UC San Diego was the senior author on the study and is available to speak on the subject in English and Spanish.

Joseph R. Friedman, M.D., Ph.D., M.P.H., is a resident physician at the Department of Psychiatry at UC San Diego School of Medicine. His research combines epidemiological and anthropological approaches to studying substance use, drug overdose, mental illness, and other socially-bound causes of mortality and morbidity. He has a particular interest in the U.S.-Mexico border region, and has spent several years living and working in Tijuana, Mexico. Dr. Friedman has also previously led other landmark studies of xylazine’s spread across the United States.

Topics for Discussion:

  • Significance of xylazine’s arrival to San Diego and Tijuana.
  • Harm reduction strategies such as oxygenation management, naloxone titration and patient safety in field settings.
  • How xylazine testing strips and education empower patients in high-risk areas.
  • The need for regulatory support and resources to adapt harm reduction models to polysubstance crises.
  • Gaps in the clinical management of xylazine and opportunities for broader application of the study’s findings.

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Brain Structure Differences Provide Clues to Substance Use Risks

Original post: Newswise - Substance Abuse Brain Structure Differences Provide Clues to Substance Use Risks

BYLINE: Leah Shaffer

When studying substance use disorders, scientists had thought some of the effects on the brain could stem from use of the substances themselves: People start drinking alcohol in early teens, that alcohol has a neurotoxic effect on the developing brain that begets more alcohol drinking, and a similar dynamic occurs with other substances.

But research from Washington University in St. Louis turns that thinking around. Certain features of brain structure may be one of the factors that can contribute to substance use initiation.

WashU researchers in the department of Art & Sciences and School of Medicine studied the brain scans of nearly 10,000 children in the large-scale Adolescent Brain Cognitive Development (ABCD) Study. The idea was to compare results of scans between participants who did and did not go on to start trying substances in early teens. What they found were correlations between certain types of brain structure and those that do try substances before age 15.

“What we looked at was whether these neural differences precede any substance involvement essentially. And we do find that,” said Ryan Bogdan, ​dean’s distinguished professor of psychological & brain sciences and co-author of this research, now published in JAMA Network Open.

In the research, Bogdan, along with first author Alex Miller, assistant professor of psychiatry now at Indiana University School of Medicine, and Arpana Agrawal, the James and Juanita Wittmer Professor in the Department of Psychiatry at WashU Medicine, highlighted a number of structural differences in the cortex, including the prefrontal cortex, that may contribute to trying substances in adolescence.

Researchers emphasized this is just one piece of a puzzle in the progression of substance use, including their early home environment, and the genetic building blocks that factor into brain structure from the get-go.

Agrawal added that the brain structure features that correlate with early initiation of substance use would not mean they can use those structures as a diagnostic tool. Instead, it gives researchers a start to pin down the many factors that may lead to substance use problems down the line.

“I think this is a clue that we need to think about the relationship between substance use and brain development somewhat differently,” she said.

Out of the almost 10,000 participants in the study, approximately 3500 reported trying substances by age 15 (which mostly means small encounters with more common substances like a sip of alcohol) compared to the remainder that did not.

They compared the two groups’ brain scans from before trying substances in early adolescence and found several differences in brain structure between the two groups. The researchers used statistical tools to control for variables like family membership, prenatal exposure to substances, and the associations still held.

That small differences in these brain structure features precede use of substances in youth could point to a propensity towards early experimentation with substances, said Miller, who is also looking at how impulsivity overlaps with these structures.

“The patterns of associations that we’re seeing are of interest,” compared to what has been seen before, he added. Next steps will include filling in the puzzle pieces in the right order to sort the origin of substance use disorders.

If you or someone you know is struggling or in crisis, help is available. Call or text 988or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol conditions, visitFindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly toFindTreatment.gov or call800-662-HELP (4357)

Miller AP, Baranger DAA, Paul SE, Garavan H, Mackey S, Tapert SF, LeBlanc KH,  Agrawal A, Bogdan R. Neuroanatomical variability and substance use initiation in late childhood and early adolescence. JAMA Network Open. DOI: https://doi.org/10.1001/jamanetworkopen.2024.52027

This study was supported by R01DA54750 (RB, AA). Additional funding included: APM (T32DA015035, K01AA031724), DAAB (K99AA030808), SEP (F31AA029934), AA (R01DA54750), RB (R01DA54750, R21AA027827, U01DA055367). Data for this study were provided by the Adolescent Brain Cognitive Development (ABCD) study which was funded by awards U01DA041022, U01DA041025, U01DA041028, U01DA041048, U01DA041089, U01DA041093, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, and U24DA041147 from the NIH and additional federal partners (https://abcdstudy.org/federal-partners.html). (The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Rutgers Institute Celebrates 10 Years of Advancing Neuroscience and Brain Health Research

Original post: Newswise - Substance Abuse Rutgers Institute Celebrates 10 Years of Advancing Neuroscience and Brain Health Research

BYLINE: Tongyue Zhang

Members of the Rutgers Brain Health Institute (BHI), which brings together one of the world’s highest concentrations of neuroscience labs, celebrated 10 years of advancing brain health through research with an awards ceremony.

The institute includes more than 300 faculty and 900 trainees from 33 departments and 14 schools throughout Rutgers University. 

Over the past 10 years, BHI has established five Centers of Excellence and initiated two new centers focused on pain and neurotechnology.

Researchers at these centers study complex brain disorders:

Since its inception, BHI has expanded neuroscience funding at Rutgers. Institute leaders have recruited more than 40 faculty throughout Rutgers.

Funding from the National Institutes of Health (NIH) for Rutgers neuroscientists has more than doubled since 2015, with BHI-recruited faculty securing more than $80 million in extramural funding through 2024. Notably, Rutgers and Princeton faculty recently received a $16 million Silvio O. Conte Center P50 grant from the National Institute of Mental Health in August.

“In its first decade, the Brain Health Institute has not only strengthened Rutgers Health but also brought real benefits to the people of New Jersey and beyond,” said Rutgers Health Chancellor Brian Strom during the  10th Annual BHI Symposium in mid-November.

Celebrating Faculty Excellence

BHI marked its 10th anniversary with the 2024 Research & Service Awards ceremony held on Dec. 10 at the Zimmerli Art Museum in New Brunswick. The ceremony celebrated BHI faculty for their outstanding research and service contributions. Award recipients included:

  • Early Career Faculty “Rising Star” Research Excellence Award: Anna Konova, assistant professor of psychiatry at Rutgers Robert Wood Johnson Medical School (RWJMS) and co-director of the Rutgers-Princeton Center for Computational Cognitive Neuro-Psychiatry.
  • Mid-Career Faculty “Shining Star” Research Excellence Award: Victoria Abraira, assistant professor of cell biology and neuroscience in the School of Arts and Sciences at Rutgers–New Brunswick.
  • Senior Faculty “Super Star” Research Excellence Awards: Dipak Sarkar and Laszlo Zaborszky, Distinguished Professors from the School of Environmental and Biological Sciences at Rutgers–New Brunswick and the School of Arts and Sciences, Rutgers–Newark, respectively.
  • BHI “Outstanding Service” Award: Chiara Manzini, associate professor of neuroscience and cell biology in RWJMS.

“These awards and our 10th anniversary highlight the transformative impact of BHI’s faculty and programs,” said Gary Aston-Jones, director of BHI and the Murray and Charlotte Strongwater Endowed Chair in Neuroscience and Brain Health. “Our faculty’s research continues to address critical challenges in brain health, and our interdisciplinary approach fosters collaboration across Rutgers and beyond.”