Category: From Newswise – Substance Abuse

Newswise — Increasing access to prescription opioid painkillers may reduce opioid overdose deaths in the United States, according to a Rutgers study.

“When access to prescription opioids is heavily restricted, people will seek out opioids that are unregulated,” said Grant Victor, an assistant professor in the Rutgers School of Social Work and lead author of the study published in the Journal of Substance Use and Addiction Treatment. “The opposite may also be true; our findings suggest that restoring easier access to opioid pain medications may protect against fatal overdoses.”

America’s opioid crisis has evolved across several waves, with each increasingly fatal. Wave one, which began in the 1990s, was associated with overdose deaths because of the misuse of opioid medications.

A policy implemented during the initial wave was the creation of prescription drug monitoring programs (PDMPs), state-based initiatives that track controlled substance prescribing. While the policy made it more difficult to access prescription opioids and rates of prescribing did decrease, it had the unintended consequence of pushing people toward off-market opioids, raising the risk of accidental death, said Victor.

This led to wave two of the crisis, a surge in heroin-related deaths, beginning around 2010, followed by wave three (which started in 2013), fueled by synthetic opioids such as fentanyl.

To measure trends and sociodemographic disparities in access to buprenorphine – a common treatment for opioid use disorder – and opioid painkillers, the researchers examined toxicology data, death records, and available PDMPs from 2,682 accidental overdose deaths that occurred from 2016 to 2021 in Indianapolis, Indiana.

The researchers found fewer than half of all decedents (43.3 percent) had a PDMP record of any kind, meaning they didn’t even try to access prescription opioids. Of the 10.6 percent that had been prescribed buprenorphine, most (64.7 percent) were prescribed treatment more than 30 days prior to death, suggesting they were not actively seeking treatment.

Victor and collaborators also found racial disparities in buprenorphine and opioid prescription trends, with dispersal for Blacks significantly lower than whites (7.3 percent and 21.9 percent versus 92.7 percent and 77.7 percent, respectively).

“Buprenorphine uptake is associated with significantly reduced rates of nonfatal and fatal overdose,” the researchers wrote. “Despite these positive treatment outcomes, several barriers remain to the widespread uptake of [medications for opioid use disorder] in the United States,” such as stigma and cost.

“For these reasons, a lack of adequate buprenorphine prescribing, combined with reductions in the availability of opioid analgesics, have left individuals contending with [opioid use disorder] at an elevated risk of overdose,” they concluded.

Given these trends and past research, Victor said it is time to re-evaluate policies that make it nearly impossible to obtain opioid prescriptions, even for those with a legitimate need.

“A big reason that we have such a problem with addiction in this country is because people can’t access legitimate pain medication,” he said. “Our findings support a change in policy.”

A study of Medicare data found that very few patients hospitalized for alcohol use disorder (AUD) were treated with an approved medication to promote behavior change. The researchers say interventions to increase prescribing by generalists and non-addiction specialists are needed to increase medication prescribing in this high-risk population. The report is published in Annals of Internal Medicine.

Newswise — Experiencing and sharing emotions is a fundamental human experience. Empathy is the ability to understand another’s perspective and share their emotions. Recent research has found that empathy can help adolescents reduce their substance use. These results will be shared at the 46^th annual scientific meeting of the Research Society on Alcohol (RSA) in Bellevue, Washington.

“Our capacity to understand and feel connected with others is critical for our mental, physical, and social health,” said Drew E. Winters, Postdoctoral Fellow at the University of Colorado Anschutz Medical Campus. “Empathy … builds a felt sense of connection and understanding of others. An example of empathy is when you see someone having an emotional reaction and you have an internal reaction approximating what it would feel like if you were in that situation. Understanding the experience of others is critical information to help guide our behavior. Lower levels of empathy have been shown to associated with engaging in behavior that is harmful to oneself and others.”

Winters will discuss his findings at the RSA meeting on Monday, 26 June 2023.

“My study is specific to adolescents in substance-use treatment,” he said. “Those that developed higher levels of empathy through treatment had steeper drops in substance use over time because of its influence on how they respond to social consequences from substance use. This finding suggests a declining level of use is due to a greater sense of connection with others, and gaining greater access to social data about the consequences of their continued use. With this data more readily available, they are motivated to change substance use.”

Winters said that social and emotional learning during youth is particularly important for those who struggle interpersonally. “Social impairments related to substance use disorders are likely bidirectional,” he observed, “meaning that substance use can influence social impairments, and social impairments can influence the severity of substance use.”

Fortunately, he added, “we can see that empathy can be cultivated, which can improve mental health and potentially motivate decreases in substance use.” Winters hopes that his research can help members of the public recognize there is a social aspect to substance abuse and see that an individual’s capacity to understand and connect with others is an important factor in the persistence of substance use.

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Winters will present his findings, “Adolescent substance use outcomes in response to social consequences of use: the role of empathy,” during the RSA 2023 meeting in Bellevue, Washington on Monday, 26 June 2023. More information can be found at RSoA on Twitter @RSAposts. The author can also be reached on Twitter @drewinters.

Newswise — Staying up late at night has little impact on how long ‘night owls’ live, according to new research published in the peer-reviewed journal Chronobiology International.

Data based on nearly 23,000 twins, however shows that evening types have a slightly increased risk of dying than morning types, but this is largely linked to smoking and drinking.

The study which tracked people over the course of more than 37 years in Finland suggests that lifestyle should be considered.

This is when analyzing the impact on health of chronotype – the body’s natural inclination to sleep at a certain time.

“Our findings suggest that there is little or no independent contribution of chronotype to mortality,” says author Dr Christer Hublin, from the Finnish Institute of Occupational Health in Helsinki.

“In addition, the increased risk of mortality associated with being a clearly ‘evening’ person appears to be mainly accounted for by a larger consumption of tobacco and alcohol. This is compared to those who are clearly ‘morning’ persons.”

There is increasing evidence that sleep duration and quality, and night shift work affect health. Earlier studies have linked night owls with a higher risk of disease especially heart problems.

Data published in 2018 from the UK Biobank, looking at people over the course of 6.5 years, found evening types have a small increased risk of death from any cause including disease, and from heart condition.

It was this previous research which inspired today’s new study, as authors wanted to analyze some things which were not measured – alcohol consumption and the amount people smoked, rather than just status.

This new research, which was co-led by Dr Jaakko Kaprio, from the Finnish Twin Cohort study at the University of Helsinki, followed 22,976 men and women aged 24 years and from 1981 to 2018.

At the start of the study, the twins were asked to pick from four possible responses: ‘I am clearly a morning person’; ‘I am to some extent a morning person’; ‘I am clearly an evening person’; ‘I am to some extent an evening person’.

The researchers followed-up the participants in 2018 to establish if any had died. They based this on data provided by nationwide registers.

The authors took into account education, daily alcohol consumption, smoking status and quantity, BMI, and sleep duration.

Results showed that 7,591 of the twins identified as ‘to some extent’ and 2,262 as ‘definite’ evening types. The figures for morning types were 6,354 and 6,769, respectively.

Compared to morning types, night owls were younger and drank/smoked more. Definite evening types were also less likely to report getting 8 hours sleep.

Of the total participants, 8,728 had died by 2018 and the chance of dying from any cause was 9% higher among definite night owls compared to early birds.

However, the study found that smoking and alcohol largely caused these deaths, not chronotype. This finding was highlighted by the fact non-smokers were at no increased risk of dying.

The causes of deaths from alcohol included related disease as well as from accidental alcohol poisoning.

Dr Kaprio notes that they were more able to relate their findings to society as a whole. Their participants’ health was no different than the general population whereas the UK Biobank’s were healthier than average.

They highlight the access to comprehensive data on lifestyle factors as a strength of their research. However, the findings were based on self-reported data from asking one question.

Newswise — Cannabis is one of the world’s most commonly used illegal drugs. New research suggests that cannabis use disorder is more strongly linked with the development of mental disorders than previously assumed.

The study includes register data from more than six million Danes and its findings indicate that cannabis use disorder increases the risk of both psychotic and non-psychotic depression and bipolar disorder.

“When we take differences in gender, age, socioeconomics and family history, and more into account, we see that cannabis use disorder is associated with almost twice the risk of developing depression and a two-to-three-times higher risk of developing bipolar disorder in both men and women,” says Oskar Hougaard Jefsen, a PhD student from the Department of Clinical Medicine at Aarhus University. He is the lead author of the study, which has just been published in the scientific journal JAMA Psychiatry.

According to the Danish Health Authority, one in three Danes under the age of 25 has smoked cannabis. However, the new study only focuses on people with a significant consumption of cannabis such that they have been registered with a substance use disorder – e.g. because they have been in contact with the substance abuse treatment system or other parts of the healthcare system.

More countries are legalising cannabis

Several studies have supported the hypothesis that extensive cannabis use is not harmless to human mental health. For example, previous studies suggest that cannabis use disorder can increase the risk of developing schizophrenia. But until now, the risk of other mental disorders has been sparsely studied.

In this study, researchers from Aarhus University and the University of Copenhagen have analysed data from Danish nationwide registers such as the National Patient Register, the Danish Psychiatric Central Research Register and the Danish Register of Pharmaceutical Sales.

“The study is the largest of its kind in the world, and our findings suggests that cannabis use disorder is also associated with an increased risk of developing depression and bipolar disorder. The results recommend caution when it comes to using cannabis. This applies to people with an increased risk of developing mental illness, and to politicians and other decision-makers who are discussing the possibilities of legalising cannabis,” says Oskar Hougaard Jefsen.

An increasing number of countries are legalising the production and sale of cannabis for medicinal and recreational use. Since 2018, general practitioners in Denmark have been able to write prescriptions for drugs based on cannabis for patients as part of a trial scheme that also gives companies and individuals the opportunity to produce cannabis for medicinal or industrial use.

Oskar Hougaard Jefsen believes that the results of the study should be considered when it comes to legalising and controlling cannabis use.

“We should conduct more research into whether there are people for whom cannabis is particularly harmful. This could strengthen preventative measures,” he says, adding that there is a particular need for more knowledge about the dose-dependent effects of cannabis use on the brain, cognition and behaviour, and for identifying risk factors for the transition from cannabis use disorder to psychiatric disorders.

No conclusive evidence

Oskar Hougaard Jefsen points out that, despite the indications in the study, it does not provide conclusive evidence that cannabis causes these mental disorders.

For example, he cannot rule out that undiagnosed depression or bipolar disorder has led some of the people in the register-based study to develop cannabis use disorder – i.e. the disease resulted in the abuse and not the other way around.

“But when we see an increased disease risk – even ten years after the cannabis use disorder has been registered – I don’t think that self-medication can be the only explanation. It seems unlikely that so many people would go undiagnosed for so long,” he says.

“Danish register data really gives us a unique opportunity to take into account many of the crucial factors that could affect the results. However, conclusive evidence would require a randomised controlled trial in which a group of people would have to smoke large amounts of cannabis to see if this increased their risk of developing mental illness in the long term, and such a study would of course be unethical,” he says.

Newswise — Hackensack Meridian Neuroscience Institute at JFK University Medical Center announced today that it has been awarded a major research grant from the National Institute on Alcohol Abuse and Alcoholism, part of the U.S. National Institutes of Health, to study a novel approach to treat damage to the central nervous system from chronic alcohol abuse. The two-year award of $464,887 is part of the highly competitive NIH grant application process that recognizes innovative scientific projects. NIH-funded research has led to scientific breakthroughs and new treatments that help people live longer, healthier lives.

The NIH grant will fund a project entitled “Peptide therapy for alcohol-induced central nervous system injury,” proposed by Mohammed Abdul Muneer, MSc, PhD, Research Scientist & Principal Investigator, Hackensack Meridian Neuroscience Institute at JFK University Medical Center, and associate professor of Neurology at the Hackensack Meridian School of Medicine.

Their work hypothesizes that the neuroinflammation, neurodegeneration and cognitive deficits that result from alcohol-induced oxidative damage to neurons in the brain can be repaired by activating the antioxidant signaling Nrf2 (nuclear factor E2-related factor 2) pathway using a small Nrf2 activator III peptide, referred to as Nrf2 peptide.  

“We at the Hackensack Meridian Neuroscience Institute at JFK University Medical Center are both honored and humbled to be awarded this NIH grant,” said Gregory J. Przybylski, M.D., MBA, chairman, Neuroscience Institute at JFK University Medical Center, and professor of Neurosurgery at the Hackensack Meridian School of Medicine. “Our neuroscientists are working to unravel the complex mechanisms of the diseases of the brain and central nervous system. This project is a great example of how our innovation has the potential to deliver possible new approaches to treat brain diseases. Congratulations to Dr. Muneer for this remarkable achievement”.

Scientists at the Hackensack Meridian Neuroscience Institute at JFK University Medical Center and other research centers have demonstrated that oxidative signaling is the central mechanism in alcohol-induced injury that leads to neurological and functional deficits. Remediation of accumulating oxidative radicals may serve as an effective strategy for preventing the progression of neurological damage in people with alcohol use disorder.

Oxidation is a chemical reaction (loss or gain of electrons) that occurs when a substance comes into contact with oxygen or another oxidizing substance, such as alcohol. Examples of oxidation are rust and the brown color on a cut apple. A peptide is a molecule that contains two or more amino acids. Peptides can engage with and activate various receptors in the body and may influence recovery.  

“My research team and I will study the effect of the Nrf2 peptide in preclinical studies, including a group of tests that include cognitive and sensory-motor functions and psychological stress to better understand the effect of Nrf2 peptide in functional recovery from alcohol use disorder, and the findings from this study will have extensive clinical relevence,” said Dr. Muneer.  

“The Neuroscience Institute at JFK University Medical Center has been in existence for over 30 years,” said Gay Holstein, PhD, translation research, Neuroscience Institute at JFK University Medical Center. “We are honored to receive this research grant and look forward to the findings.”

Alcohol is the most commonly used and potentially addictive substance in the United States. Alcohol dependence is a chronic and debilitating condition that causes significant medical complications and mortality. Chronic alcohol abuse results in neuronal degeneration and functional deficits in sensory-motor, memory, psychological, and cognitive functions.  Alcohol abuse disorder is a highly prevalent and disabling disorder that is often present with other medical and mental-health conditions. Alcohol dependence, abuse and harmful use are all part of alcohol abuse disorder. 

Newswise — The Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health announces the 2023 Bloomberg Fellows, each selected from organizations working to improve one of five critical public health challenges facing the country: addiction and overdose, adolescent health, environmental challenges, food systems for health, and violence.

Fifty individuals were awarded full Master of Public Health scholarships, and 10 received scholarships to pursue Doctor of Public Health degrees.

The Bloomberg American Health Initiative was established in 2016 with a $300 million gift from Bloomberg Philanthropies in honor of the centennial of the Bloomberg School of Public Health. The Initiative addresses imminent challenges to health in this country through education, research, and practice.

The 2023 cohort represents fellows and organizations spanning the District of Columbia, Puerto Rico, and 25 states: Alaska, California, Colorado, Georgia, Maryland, Massachusetts, Michigan, Minnesota, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and Wyoming. 

The Bloomberg Fellows come from a wide range of collaborating organizations, including:

• Tumbling Shoals Farm, a certified-organic vegetable farm in Wilkes County, NC, whose commitment to organic practices and dedication to providing nourishment to their community have made them a cornerstone of sustainable agriculture in the region.
• Honestly: Sexual Health Collective for Youth, an organization that collaborates with partners to improve sexual health education for adolescents in Oklahoma and prevent teen pregnancy.
• Northwest Portland Area Indian Health Board, an organization within the Environmental Public Health Program, serving the 43 federally recognized tribes of Oregon, Washington, and Idaho to address health disparities and enhance the quality of life for American Indians and Alaska Natives.

“At a time when our country urgently needs strong public health leadership, we are thrilled to welcome this impressive class of Bloomberg Fellows from a diverse array of organizations,” says Bloomberg School Dean Ellen J. MacKenzie, PhD, ScM. “Through their experience at the Bloomberg School, these fellows will find new ways to drive social change and make positive, lasting impacts in their communities.”  

Since its founding, the Bloomberg American Health Initiative has worked to save lives and improve health outcomes nationwide, tackling five issues that deeply challenge the nation’s health, with an emphasis on advancing equity, changing policy, and relying on evidence-based science. 

“Saving and extending lives requires strong public health leadership—and the need for it has never been greater,” said Michael R. Bloomberg, founder of Bloomberg LP and Bloomberg Philanthropies, and WHO Global Ambassador for Noncommunicable Diseases and Injuries. “This group of fellows from over 20 states will develop the critical skills necessary to improve the health of their communities. I look forward to seeing the lifesaving work they will go on to lead across the country.”

The fellowship program provides full scholarships for full- or part-time study through the Bloomberg American Health Initiative. The fellows’ current employers support them in this work and collaborate with the Initiative, playing a key role in the program. After completing the program, fellows are then required to work for at least one additional year with their employers, applying the skills and tools acquired during their fellowship. Information about requirements and the application are available online. The next application deadline is December 1, 2023.

The 2023 Bloomberg Fellows and their collaborating organizations are:

MPH Fellows

Addiction and Overdose

• Bridget Duffy – Center for Injury Research and Policy at Nationwide Children’s Hospital – Columbus, OH
• Lauren Kemmeter – Mono County Public Health – Mono County, CA
• Monica Desjardins – Research Triangle Institute International – Triangle Park, NC
• Clement Chen – Rutgers University, New Jersey Medical School, Department of Psychiatry; Northern NJ Medication-Assisted Treatment Center of Excellence – Newark, NJ
• Isabella Izquierdo – Lewis-Burke Associates – Washington, D.C.
• Ashley Wurth – Injury and Violence Prevention, North Carolina Division of Public Health – Boone, NC
• Michelle “Misch” Whitaker – Boston Health Care for the Homeless Program – Boston, MA
• Marisa Shields – Frederick County Health Department – Frederick, MD
• Adrienne Sanders – Carroll County Health Department – Carroll County, MD
• Jeanette Trella – Center for Public Health Readiness and Response at Children’s Hospital of Philadelphia – Philadelphia, PA
• Julio Contreras – National Alliance of State and Territorial AIDS Directors – Washington, D.C.
• Zimani Betts – Hamilton County Public Health – Cincinnati, OH
• Fatumata Kaba – Boston Public Health Commission – Boston, MA
• Samantha Santamaria – University of California, Los Angeles Integrated Substance Abuse Programs – Los Angeles, CA
• Shamia Roberts – Tennessee Department of Health – Nashville, TN
• Ciara Gregovich – U.S. Drug Enforcement Administration, Rocky Mountain Division – Denver, CO

Adolescent Health

• Christa Seymour – Olmsted County Public Health – Rochester, MN
• Anna Duncan – CoLab for Community & Behavioral Health Policy – Seattle, WA
• Tomas Rivera – University of Maryland School of Dentistry – Baltimore, MD
• Sunia Young – National Academies of Sciences, Engineering, and Medicine – Washington, D.C.
• Miranda Bond – Parkland Health – Dallas, TX
• Robert “Bobby” Pourier Jr. – Johns Hopkins School of Nursing; Young Medicine Movement – Fort Belknap Indian Reservation, MT
• Ana Belén Zelaya – Healthy Futures of Texas – San Antonio, TX
• Lillian Bocquin – Honestly: Sexual Health Collective for Youth – Oklahoma City, OK
• Ariel Yardeni – National Institutes of Health, All of Us Research Program – Washington, D.C.
• Allanceson Smith – San Francisco Department of Public Health, Behavioral Health Services – San Francisco, CA

Environmental Challenges

• Katelyn Wolf – Baltimore County Department of Health – Baltimore, MD
• Melino Gianotti – Northwest Portland Area Indian Health Board (NPAIHB), Environmental Public Health Program (EPH) – Portland, OR
• Miguel Angel Vazquez – Riverside University Health System-Public Health – Riverside, CA
• Roshona Thomas – Philadelphia Department of Public Health, Division of Environmental Health Services – Philadelphia, PA
• Emily Creegan – Maryland Department of Health, Laboratories Administration – Baltimore, MD
• Shanada Monestime – GO2 for Lung Cancer – Washington, D.C. 
• Christopher Lemon – Johns Hopkins Medicine Department of Emergency Medicine – Baltimore, MD

Food Systems for Health

• Julia McCarthy – New York Health Foundation – New York, NY
• Kelsey Crawford – Tumbling Shoals Farm – North Wilkesboro, NC
• Jay Cutler – Michigan Fitness Foundation – Lansing, MI
• Elizabeth Lewis – The Center for Popular Research, Education and Policy, Wind River Food Sovereignty Project – Fort Washakie, WY
• Ariana Yett – Chipotle Mexican Grill, Inc. – Newport Beach, CA

Violence

• Alejandra Casarrubias – Casa de Salud – Albuquerque, NM
• William Wisner-Carlson – Baltimore Community Intelligence Center, Baltimore City Police Department – Baltimore, MD
• Pamela End of Horn – U.S. Department of Health and Human Services’ Indian Health Service (IHS) – Longmont, CO
• Megan Amaturo – International Association of Chiefs of Police – Alexandria, VA
• Beth Krafchik – New York City Health + Hospitals/ Correctional Health Services – New York, NY
• Olivia Harris – Speak About It, Inc. – Philadelphia, PA
• Rena Kates – Baltimore Police Department Training Academy, Education and Training Section – Baltimore, MD
• Maria Coss – Puerto Rico Department of Health’s Commission on Suicide Prevention – San Juan, Puerto Rico
• Ashley Hannigan – Injury Surveillance Program, Alaska Division of Public Health – Anchorage, AK
• Karolin Betances – Center for Justice Innovation – New York, NY
• Hazel Brown – Alliance for Gun Responsibility – Seattle, WA
• Sandy Chavarria – Georgia Center for Child Advocacy – Atlanta, GA

DrPH Fellows

Addiction and Overdose

• Camille Kramer – Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Advocacy and Research on Reproductive Wellness of Incarcerated People – Baltimore, MD
• Philomena Kebec – Bad River Band of Lake Superior Chippewa Indians – Ashland, WI
• Brian Kaplun – U.S. Department of Health and Human Services – Washington, D.C.

Adolescent Health

• Victoria Adewumi – City of Manchester Health Department – Manchester, NH

Environmental Challenges

• Rebecca Reindel – American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) – Washington, D.C.
• Keana Kaleikini – Collective Medicine – Farmington, NM

Food Systems for Health

• Lauran Larson – Oklahoma State Department of Health – Oklahoma City, OK
• Angela Suarez – La Clinica del Pueblo – Washington, D.C.
• Sarah Reinhardt – U.S. Department of Agriculture, Food and Nutrition Service – Washington, D.C.

Violence

• Sarah Newman – Booz Allen Hamilton – Washington, D.C.

More about the Bloomberg American Health Initiative is available at americanhealth.jhu.edu.

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Newswise — A new clinical trial run by Howard University, the University of Illinois Chicago and the University of Miami Miller School of Medicine will partner with community organizations and sites to bring life-saving care closer to a highly vulnerable population – Black people with opioid use disorder.   

The Better Together trial will utilize non-medical neighborhood sites such as churches, community centers and homeless shelters to establish and maintain patients on buprenorphine, an effective medical treatment for opioid dependence. The study, funded by the National Institutes of Health’s National Institute on Drug Abuse, will test the community-focused approach at sites in Chicago, Miami and Washington D.C.  

The trial will be co-led by Dr. Niranjan Karnik of UIC, Dr. Richard Schottenfeld of Howard University, and José Szapocznik of UM. The clinical trial builds on the Better Together pilot program developed by Howard University’s department of psychiatry and behavioral sciences, in partnership with its community advisory board.  

Supported by the National Drug Abuse Treatment Clinical Trials Network, the study will use a community-engaged hub-and-spoke model of providing treatment to persons with opioid use disorder, with participants receiving counseling and peer support at local neighborhood locations supported by remote prescription and management of buprenorphine from university physicians via telehealth at some sites and at a local community center in Miami that largely serves African Americans.  

“We know that there are evidence-based, life-saving interventions that work to treat opioid use disorder,” said Karnik, visiting professor of psychiatry at UIC. “The difficulty is getting them to the people who need them the most.”  

Within the broader opioid crisis, Black people suffer drug overdose deaths at a higher rate than other racial groups and lag in the use of proven addiction treatments. Experts cite health care access, the stigma against people who use opioids and mistrust of the medical system as significant barriers to reaching these at-risk patients and enrolling them in care.  

Recent policy changes have made it easier to prescribe and distribute buprenorphine, a medication that substitutes for powerful drugs such as heroin or oxycodone and safely decreases craving and withdrawal symptoms. But to be effective, patients must take the drug daily and maintain regular contact with a medical professional for refills and monitoring.  

“It is critical that persons who suffer from opioid use disorder stay on buprenorphine until they have made the profound personal and social changes that are needed to promote a drug-free lifestyle. Only then, should these individuals stop taking the medication,” said Szapocznik of the department of public health sciences at UM. “This includes changes in housing, habits, coping and life skills, and most importantly social support networks. The study will be working with community programs that can assist persons in achieving these goals.” 

By moving care from medical centers to community locations, the researchers expect multiple benefits for patients receiving treatment for their opioid use disorder. For many people, it will reduce the distance they need to travel for regular visits. Alongside intermittent remote check-ins with physicians, support will also be provided in a comfortable, familiar environment by peers from the patient’s community.  

Schottenfeld, professor and chair of the department of psychiatry and behavioral sciences at Howard University, said ideas used in the clinical trial resulted from focus group research and a multi-year partnership between researchers and community advisers in Washington, D.C.  

“We tried to understand why Black people with opioid use disorder aren’t coming in for treatment,” Schottenfeld said. “We found that enormous amounts of stigma, misunderstandings about addiction and bias against certain types of treatment are barriers to bringing people in and keeping them in treatment.”   

Patients in the new study will follow a treatment program with peer recovery support specialists and community engagement and retention specialists, who have often gone through recovery themselves.   

By developing relationships with credible messengers and centering treatment in trusted community organizations and working together with credible messengers in the community, the Better Together program builds on existing community strengths and resources. Schottenfeld said the pilot has so far succeeded in attracting and engaging people who need treatment closer to home provided by people they trust.   

Participants in the Better Together trial will be compared against a control group receiving buprenorphine and related support in a standard-of-care medical clinic environment. Researchers will examine not only the medical outcomes of the treatment but also factors such as retention and patient satisfaction that would help effectively serve opioid users over the long term.   

The Better Together trial will concentrate its initial activities in areas of the three cities hard hit by the opioid crisis. In the first phase of the study, research teams will form community advisory boards in their respective locations and select key community partner organizations and potential treatment sites embedded within the priority neighborhoods.   

The trial is funded by NIDA grant 3UG1DA049467-05S1 and is part of the National Institutes of Health Helping to End Addiction Long-Term Initiative. The total grant is for five years and $14.2 million, which will be shared by the three institutions.  

More information about the study will be available at the NIDA Clinical Trials Network website under CTN-0144.  

Newswise — More than 37% of adults receiving office-based treatment for opioid use disorder (OUD) reported experiencing suicidal thoughts over their lifetime, and 27% reported attempting suicide, rates that are “notably higher” than the general population (15.6% and 5%, respectively), according to a Philadelphia College of Osteopathic Medicine study that also identifies predictors for suicidality in people with OUD. The findings may better identify at-risk patients and inform mental health prevention and treatment efforts.

“The elevated rates of lifetime suicidality found in individuals in recovery from opioid use disorder suggest the need for regular screening for suicidal thoughts in this patient group,” said lead author Michelle R. Lent, PhD, an associate professor of Clinical Psychology at PCOM. “These findings also underscore the importance of multifaceted addiction treatment approaches that address mental health issues and other psychosocial concerns, in addition to substance misuse.”

The study, published this month in Addiction Science & Clinical Practice, examines the prevalence of, and factors associated with, suicidality in adults with OUD who initiated office-based treatment for the medication buprenorphine, which is associated with improvements in suicide risk, due in part to its “potential to minimize pain-induced aversive moods” and its “ability to foster engagement in medical care,” according to the study.

While medications such as buprenorphine are “effective and lifesaving,” mental health issues associated with OUD can take people away from their recovery goals, Lent said, emphasizing that OUD intervention “has to be more than medication.”

In the study, 244 adults completed semi-structured interviews about their mental health experiences. All were enrolled in clinical trials for OUD treatment at Federally Qualified Health Centers in Pennsylvania or New Jersey that are affiliated with the Greater Philadelphia Opioid Use Disorder Research Group.

Lifetime depression, anxiety, physical or sexual abuse, having a chronic pain-related condition (such as arthritis or migraine), lifetime use of more than one drug, being on parole or probation, and years of education correlated with suicidality. Respondents of Hispanic or Latinx ethnicity reported elevated rates of suicidal ideation and attempts. Lent said a topic of future inquiry for addiction researchers could be more exploration of why people of Hispanic or Latinx ethnicity may be at greater risk than the general population.

“Given the very high prevalence of lifetime suicidality in our sample, regular screening and monitoring for suicidality may be warranted” in people starting medication-based treatment for OUD “given the challenges in multiple life domains that can accompany both OUD and recovery,” the authors wrote, concluding that office-based OUD clinics “would benefit from integrated behavioral health services that can improve clinical response to the mental health needs of patients.”

This research was supported by funding from the Patient-Centered Outcomes Research Institute (lead institution, Philadelphia College of Osteopathic Medicine) and the Pennsylvania Department of Health (lead institution, Public Health Management Corporation) for two ongoing clinical trials from which this study was conducted.

Newswise — PROVIDENCE, R.I. [Brown University] — For decades, efforts by police to seize illicit drugs have been a cornerstone strategy for disrupting drug markets and removing drugs from communities. But there’s an unintended outcome when opioids are seized, a new study finds — increases in overdoses, including those that are fatal.

The study found that police drug seizures were associated with increases in fatal overdose in the surrounding geographic area in the three weeks following enforcement, possibly by leading people with substance use disorder to take greater risks when they tried to restore their supply. The study, published in the American Journal of Public Health, raises questions about policies that might be exacerbating overdoses during a persistent epidemic that is contributing to reductions in the nation’s life expectancy.

The findings provide evidence that efforts to disrupt drug markets can have unintended effects in generating public harm, said Bradley Ray, a senior researcher at the nonprofit research institute RTI International who led the study. 

“It’s concerning to think routine drug enforcement can exacerbate harms, so we need to focus on mitigating these sources of overdose risk,” Ray said. 

Brandon del Pozo, an assistant professor (research) at Brown University’s Warren Alpert Medical School and School of Public Health, co-authored the study. Del Pozo spent 19 years at the New York City Police Department and four years as chief of police of Burlington, Vermont, where he directed the city’s response to the opioid crisis. The study highlighted the “collateral consequences” of law enforcement seizures of drugs, del Pozo said.

“To be truly effective in reducing overdose deaths, policing strategies need to be comprehensive,” he said. “That means taking into account all the outcomes of police work, not just the effect of incapacitating drug dealers, but also how seizing drugs disrupts sales in a community, and how those disrupted sales affect usage patterns, and how those usage patterns affect an individual’s health and safety. According to this study, we have evidence that seizing opioids increases exposure to overdose.”

To conduct the study, the research team used two years of administrative data from Marion County, Indiana, to compare different types of drug seizures with subsequent changes in fatal overdoses, nonfatal overdose calls for emergency medical services and naloxone administration in the surrounding area.

They found that within seven, 14 and 21 days, opioid-related seizures of drugs by police were significantly associated with increased overdoses within 100, 250 and 500 meters of the seizure location. Most notably, the number of fatal overdoses was two-fold higher than expected within seven days and 500 meters following an opioid-related incident in which police seized drugs.

The researchers hypothesized that the increase in overdose events was because people who use opioids will generally seek out a new supply after losing access to their previous drug supply, and that new supply will have unknown potency. In addition, in the time period between losing the familiar supply and finding a new one, people using opioids can experience diminished tolerance to drugs. Accidentally ingesting a dose beyond one’s tolerance can be fatal.

“One of the risks of the illicit drug market is uncertainty about what constitutes a safe dose,” Ray said. “If people who use drugs lose access to their usual supply, they are forced to find an unknown supplier, which introduces uncertainty about what is in the drugs they procure, thereby increasing overdose risk.”

Fentanyl — a highly potent opioid often used to lace other heroin or cocaine that has come to dominate the illicit opioid market — is driving the fatality count in opioid- and stimulant-involved overdose deaths, the researchers noted. Much of the drug supply is now contaminated by fentanyl, which is lethal even in small doses.

“The ubiquity of fentanyl in the drug supply affords people who use drugs almost no margin of error if they make a dosing mistake,” del Pozo said.

The study findings, del Pozo said, can inform a more effective law enforcement strategy for preventing overdoses. For example, he said that it’s important to ensure that a drug seizure in a particular area is also accompanied by targeted harm reduction approaches such as outreach services, links to treatment, increased naloxone distribution and programs that test illicit drugs for the presence of fentanyl.

“If the seizure of drugs by law enforcement is going to continue to be a part of the strategic response to the country’s overdose crisis, then it has to take into the account that at least in the short term, seizing drugs increases overdoses,” del Pozo said. “Part of the mission of drug enforcement is to save lives, and with the current approach, it’s doing the opposite.”

Other study contributors included Steven J. Korzeniewski, Grant Victor, Philip Huynh and Bethany J. Hedden from Wayne State University; George Mohler from Boston College; and Jennifer J. Carroll from the Warren Alpert Medical School at Brown University and North Carolina State University.

The study was funded by the U.S. Centers for Disease Control and Prevention.