Category: From Newswise – Substance Abuse

Newswise — A statewide effort to treat the pain of surgery patients without increasing their risk of long-term dependence on opioids has paid off in Michigan, a study shows.

In less than two years, the effort led to a 56% reduction in the amount of opioids patients received after having six different common operations, and a 26% drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased.

Both of those drops beat national trends for similar patients, according to the new study published in Annals of Surgery by a team from Michigan Medicine, the University of Michigan’s academic medical center.

Michigan patients having certain operations – for instance, to remove part of their colon – saw the biggest drops over the study period in how many opioids they received after their operations. They also had the biggest drop in risk of developing persistent opioid use, which the researchers define as filling opioid prescriptions for months or years after surgery, when their initial surgery-related prescription was intended for short-term use.

The Michigan effort used prescribing guidelines based on real-world evidence about how many opioid doses surgery patients actually need to ease their pain, compared with what they were prescribed.

Importantly, the guidelines don’t leave patients in pain. In fact, past research showed that surgery patients receiving smaller opioid prescriptions had similar pain outcomes and were just as satisfied with their pain care.

“Tens of millions of people have operations in the U.S. every year, and most of them go home with a prescription for an opioid painkiller. Although they are meant for short-term use during recovery from surgery, unfortunately, some patients keep filling opioid prescriptions for months or years after surgery, which raises their risk of opioid use disorder, overdose, and death,” said Ryan Howard, M.D., M.S., the resident in the U-M Department of Surgery who led the new analysis. “Reducing those trends is a key part of addressing our national opioid problems.”

A statewide team effort

The achievement was driven by the Opioid Prescribing Engagement Network and the Michigan Surgical Quality Collaborative – both based at U-M – and by surgical team leaders at 70 hospitals across the state that take part in MSQC and have implemented OPEN guidelines.

“Our study shows how voluntary prescribing guidelines, and involvement of surgical teams in choosing evidence-based pain care options, can really make a difference,” said senior author Chad Brummett, M.D., co-director of OPEN and director of pain research at Michigan Medicine’s Department of Anesthesiology. “Fewer opioids prescribed and dispensed means lower risk not only of persistent use, but also of risks to others in the household from unused opioid medication.”

Helping patients get leftover opioids out of their homes and disposed of safely is another key goal of the opioid prescribing engagement network. They offer several free programs to Michigan organizations including free medication disposal pouches, permanent disposal boxes and medication take back event planning materials.

Making Michigan the safest place for surgery

The team showed that declines in Michigan – where these guidelines were implemented – outpaced the nation, and other Midwest states, by comparing records from tens of thousands of patients who had the six types of operations in Michigan and those who had them in other states.

Their analysis spans almost four years before the prescribing guidelines were deployed statewide, and nearly two years afterward, from 2013 to mid-2019.

They focused on patients covered by traditional Medicare, who had not filled an opioid prescription for a year before their operation, and who had not had a second operation in the six months after their index operation.

The study focuses on nearly 25,000 Michigan patients and more than 118,600 non-Michigan patients who had minimally invasive gallbladder removal or appendix removal, minor or major hernia repairs, removal of part of the colon (colectomy), or hysterectomy.

Those six types of operations were the first ones that focused on when developing and implementing prescribing guidelines based on opioid prescription fills and surveys of patients undergoing surgery. They were first published in October 2017, and have been added to ever since with guidelines for other types of surgical and dental procedures. The opioid prescribing engagement network recently published its first pediatric surgery prescribing guidelines.

The 70 hospitals across Michigan where the guidelines were deployed account for the majority of surgical care in the state. The non-Michigan patients were a 20% sample of all traditional Medicare patients who had the same operations in the same timeframe.

The researchers looked for signs of new persistent use of opioids, which means a patient filled an opioid prescription immediately after surgery, and then also filled at least one more opioid prescription in the three months after surgery, and another up to six months after surgery. They also looked at the total amount of opioids that patients received in the six months after their operation.

Because opioid prescribing in general was trending downward in the mid-2010s, the researchers looked at differences between Michigan and national trends to see if there was any difference.

Michigan outperforms the nation

Michigan patients had a larger decrease in the rate of new persistent opioid use than their non-Michigan counterparts, with the two drops differing by about half a percentage point.

This was driven especially by a 2.76 percentage-point reduction among those having colon surgery, and smaller but significant reductions among those having gallbladder and minor hernia operations. Patients having other operations had either no difference between Michigan and the rest of the nation, or a slight increase in Michigan for appendectomy.

On the whole, Michigan surgical patients saw a faster drop in the size of the opioid prescriptions they filled, compared with those in other states having the same operations in the same time period.

The difference was nearly 56 mg of opioids by the end of the study period, with significant drops in all types of surgery except laparoscopic appendectomy. Michigan patients started at about 200 mg morphine equivalents, and dropped to 89 mg morphine on average, while non-Michigan patients started at 218 mg morphine and dropped to 154 mg morphine.

The size of dispensed opioid prescriptions to Michigan surgical patients was actually already lower than national surgical opioid prescribing before the guidelines, though persistent opioid use after surgery was higher in Michigan at 3.4% compared with 2.7%.

When the researchers excluded cancer patients, or patients with substance issues, Michigan still outperformed the rest of the country in decreasing persistent use and reducing the size of prescriptions dispensed to patients.

Michigan’s colon surgery patients had the biggest drop in both the amount of opioids they received and their chance of developing persistent use.

The researchers also did additional comparisons of Michigan with a group of Midwestern states, and with Indiana and Wisconsin, as well as doing analyses that excluded cancer patients and patients who had previously been diagnosed with a substance use disorder. In all these cases, Michigan performed better than the nation.

Both MSQC and OPEN receive funding from Blue Cross Blue Shield of Michigan. The opioid prescribing engagement network also has received funding from the Michigan Department of Health and Human Services and National Institutes of Health, as well as support from the U-M Institute for Healthcare Policy and Innovation.

In addition to Howard and Brummett, the study’s authors are Andrew Ryan, Ph.D., formerly of the U-M School of Public Health, Hsou Mei Hu, Ph.D., M.B.A., of OPEN; Craig S. Brown, M.D., M.S., of Surgery; and OPEN co-directors Jennifer Waljee, M.D., M.P.H., M.S., Mark Bicket, M.D., Ph.D. and Michael Englesbe, M.D. Many of the authors are members of IHPI and the Center for Healthcare Outcomes and Policy.

Paper cited: “Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery,” Annals of Surgery. DOI: 10.1097/SLA.0000000000005792

BYLINE: Deion Wright

Newswise — Receiving medication for opioid use disorders, such as buprenorphine after an overdose, leads to lower mortality risk, according to a Rutgers study.

Drug overdose deaths are a significant public health concern in the United States. According to the National Center for Health Statistics, there were more than 105,000 drug overdose deaths in 2021, which were largely attributed to opioids. Rutgers researchers found that opioid-involved overdose deaths following nonfatal overdose events are largely preventable with buprenorphine medication for opioid use disorder.

The medication, approved by the Food and Drug Administration, is a highly effective treatment for opioid use disorder that can be prescribed or dispensed in physician offices. However, fewer than one in 20 individuals studied received buprenorphine after experiencing a nonfatal opioid overdose, according to the study.

“Within the health care system, we need to expand availability and use of buprenorphine in general medical settings, including emergency departments and telehealth visits, and to continue working to reduce the stigma associated with substance use disorder and medication treatment more broadly,” said Hillary Samples, assistant professor at the Rutgers School of Public Health and lead researcher of the study.

The study, published in the American Journal of Preventive Medicine, used national Medicare beneficiary data to identify adults with disabilities ages 18 to 64 years who received inpatient or emergency treatment for nonfatal opioid overdose from 2008 to 2016. Analyses examined patterns of opioid use disorder treatment after surviving a nonfatal overdose to estimate the relationship of buprenorphine medication and psychosocial services with risk of overdose death in the following year.

Researchers found that receiving buprenorphine after a nonfatal opioid overdose was associated with a 62 percent reduction in the risk of subsequent opioid overdose death. The findings highlight a need to initiate potentially lifesaving treatment following nonfatal opioid overdoses because these events are strong risk factors for repeat overdose and death. Current evidence on opioid use disorder treatment after opioid overdose consistently shows low uptake of medication for opioid use disorder such as buprenorphine, including less than 5 percent of patients in this study.

“Interventions that focus specifically on disadvantaged groups are needed to address disparities in treatment access,” said Samples, who is a faculty member at the Center for Pharmacoepidemiology and Treatment Sciences at the Rutgers Institute for Health, Health Care Policy and Aging Research (IFH). “This is particularly important for patients with disabilities who potentially face greater barriers to care, like transportation difficulties or scheduling challenges related to individual or caregiver obligations at home and work.”

Other authors of the study include Stephen Crystal and Molly Nowels of IFH as well as Arthur Williams and Mark Olfson of the Columbia University Department of Psychiatry.

What: According to a recent Washington Post article, prescriptions for Adderall rose more than 30% over the past five years and accelerated during the pandemic. Now, there is a nationwide shortage of the drug.

Nearly 40% of all prescriptions for stimulants, including Adderall, were based on telehealth visits last year. After a federal emergency declaration, the DEA in March 2020 waived the requirement for in-person evaluations to prescribe controlled substances — regulated because of their potential for abuse. With the emergency declaration set to expire on May 11, the DEA published a proposed rule that would formally allow prescribing controlled substances by telehealth but imposes new conditions on it.

When: March 23, 2023 to May 11, 2023

Who: Danielle M. Alm, PharmD, BCPS, BCPPS, associate professor of clinical pharmacy, pediatrics

Quote from Dr. Alm: 

“From a pediatric perspective, I feel the COVID pandemic has increased the population of patients with ADHD as the pandemic has caused more stress. These patients are vulnerable to the distress caused by the COVID pandemic, which can, in turn, increase their behavioral problems,” said Alm.

“Furthermore, with the pandemic and telehealth options becoming available, I believe more adolescents sought the opportunity to get help for their ADHD and received treatment, one of which would be Adderall. These patients most likely did not have access to physician visits prior to telehealth becoming available for various reasons, especially in underserved areas. If telehealth physician visits are stopped, I believe this will jeopardize access for many patients.”

Media Contact: Kevin Gfeller, assistant director of public relations at Saint Joseph’s University. 

Email:

About Saint Joseph’s University

Founded in 1851 as Philadelphia’s Jesuit university, Saint Joseph’s University prepares students for a rapidly changing world by focusing on academic excellence and courageous exploration. With an intellectual tradition distinguished by a foundational liberal arts core and diversified by strong professional programs in education, business, health and science, Saint Joseph’s students are empowered, challenged and supported by faculty-scholar mentors to follow their own path. There are nearly 8,000 undergraduate and graduate students in the University’s four schools and colleges — the College of Arts and Sciences, the Erivan K. Haub School of Business, the School of Education and Human Development, and the School of Health Professions. With academic offerings in the most sought-after majors, including leading programs in the first-in-the-nation Philadelphia College of Pharmacy, nearly 100% of students are employed, pursuing advanced degrees or volunteering in prestigious service programs upon graduation. The University’s two networks of nearly 100,000 proud alumni keep alive the rallying cry — The Hawk Will Never Die.

Newswise — STONY BROOK, NY, March 22, 2023 – Clinicians and other professionals trying to stop the opioid crisis in the United States need all the tools they can to accurately identify communities at risk of large increases in deaths from opioid use and prevent deaths. A study led by a team of computer scientists at Stony Brook University and published in Nature Digital Medicine presents a unique approach using artificial intelligence (AI) and social media posts to predict opioid mortality rates. The findings revealed that a sophisticated AI algorithm was able to predict opioid death rates – going back from previous years 2011 to 2107 – much more accurately than using traditional information researchers and clinicians often use, such as prior rates in communities and socio-economic measures.

According to the National Center for Health Statistics, the U.S. has been tackling an opioid epidemic for more than two decades. And age-adjusted opioid-related deaths have increased by some 350 percent over the 20 years of 1999 to 2020.

Lead Author Matthew Matero (PhD student in Computer Science at Stony Brook), senior author H. Andrew Schwartz (Associate Professor in Computer Science) and National Institute on Drug Abuse Data Scientist Salvatore Giorgi created TrOP (Transformer for Opioid Prediction), a new model for community-specific trend projections that uses community-specific social media language, along with past opioid-related mortality data to predict future changes in opioid-related deaths.

According to the authors, TrOP builds on recent advances in sequence modeling, namely transformer networks, to use changes in yearly language on Twitter, and past mortality, to project the following year’s mortality rates in many U.S counties.

They used language data derived from the County Tweet Lexical Bank, a dataset that contains word usage on Twitter collected from more than 2,000 U.S. counties starting from 2011. They built yearly topics or groupings that appeared together for each county from 2011 to 2017.

Using this language data as a central point, they combined it with data queried from the Centers for Disease Control and Prevention to gather the yearly opioid-related deaths per county. They then limited the full dataset to only U.S. counties that reported opioid-related deaths for all of the years 2011 to 2017. This totaled data from 357 counties, which includes some 212 million people thus nearly two-thirds the population of the U.S.

This method predicted rates of opioid-related deaths that actually took place in the future with surprising accuracy.

“The main result of this study was in fact a statistical evaluation of how well our AI model’s predictions lined up with what really happened, and doing this without assuming any particular language used in social posts should equate to mortality,” explains Schwartz.

They found that the proposed model of predicting opioid-related deaths forecasted the actual yearly death rates within 1.15 deaths per 100,000 people, only a 3 percent absolute mean percent error.

Schwartz and his co-authors recognize the morbidity and mortality around opioid use and its prevention is a complex issue.

“Community-specific predictions are just one line of attack on what is a very complex problem that certainly needs a multifaceted and evolving response,” says Schwartz. “What this work with TrOP provides is the potential for more accurate predictions for opioid-related deaths, which would give professionals and community leaders the ability to better prepare and target areas where there is likely to be an increase in mortality.”

They will continue to assess this AI model in different ways in order to test its accuracy. And given that social media and its wording continues to change and evolve, so to TrOP may have to be adjusted and updated in order to predict opioid-related deaths in communities across the country.

The authors suggest public health officials and those seeking to address the opioid epidemic try to deploy such an AI model to improve their existing community assessments to get a better idea of the direction of the epidemic in communities and regions in the coming year or years.

They also urge that any such algorithm using an AI model with social posts should include a replication of the empirical data findings and external validity checks, and that “all results should always be taken in consultation with other evidence of community opioid-related death risks.”

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BYLINE: Julia Evangelou Strait

Newswise — A new study suggests that a common genetic signature may increase a person’s risk of developing substance use disorders, regardless of whether the addiction is to alcohol, tobacco, cannabis or opioids. The research, led by Washington University School of Medicine in St. Louis, eventually could lead to universal therapies to treat multiple substance use disorders and potentially help people diagnosed with more than one.

Published March 22 in the journal Nature Mental Health, the study’s findings are drawn from an analysis of genomic data from more than 1.1 million people of mostly European ancestry and a smaller population of people of African ancestry.

Substance use disorders have increased dramatically in recent years, with rising numbers of overdose deaths and increasing social, emotional and financial costs to families and communities. More than 46 million people over age 12 in the U.S. had at least one substance use disorder in 2021, according to the National Survey on Drug Use and Health. The most severe cases of substance use disorder typically involve use of more than one substance. However, most medications target the use of a specific substance, such as tobacco or opioids, rather than treating addiction broadly.

“There is a tremendous need for treatments that target addiction generally, given patterns of the use of multiple substances, lifetime substance use, and severity seen in the clinic,” said lead author Alexander Hatoum, PhD, a research assistant professor of psychological & brain sciences at Washington University. “Our study opens the door to identifying medications that may be leveraged to treat addiction broadly, which may be especially useful for treating more severe forms, including addiction to multiple substances.”

The study — led by Hatoum and co-senior authors Arpana Agrawal, PhD, a professor of psychiatry at Washington University School of Medicine; Ryan Bogdan, PhD, a professor of psychological & brain sciences at Washington University; Howard J. Edenberg, PhD, of Indiana University School of Medicine; and Joel Gelernter, MD, of the Yale School of Medicine — involved more than 150 researchers from institutions around the world. The research was supported by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Mental Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute on Aging, all part of the National Institutes of Health (NIH).

“This study represents a major advance in understanding how genetic factors predispose people to substance use disorders,” Agrawal said. “While we have known for a while that many genetic factors are shared between different substance use disorders, our study identified some of the contributing genes, providing avenues for future biological and therapeutic discoveries for individuals with multiple addictions.”

The genetic signature associated with substance use disorders encompasses variations in multiple genes and is linked to regulation of dopamine signaling. Dopamine is a key signaling molecule in the brain’s reward system. Studies have shown that repeated exposures to addictive substances can cause the dopamine pathway in the brain to adapt to the effects of these substances, requiring more of the substance in order to receive the same amount of reward.

Previous research has implicated dopamine signaling in addiction, but most such studies have focused on a single substance. Further, the regulation of dopamine and neuronal development from the newly discovered genetic signature can help narrow down the specific forms of neuronal communication that are affected in substance use disorders.

“Anytime we look at addiction, we think dopamine is involved,” Hatoum said. “But here, we can implicate more specific mechanisms by which the brain regulates response to dopamine across different substances, and ultimately find processes that could reverse maladaptive regulation that leads to addiction.”

As part of the study, the researchers compiled a list of approved and investigational pharmaceutical drugs that have the potential to be repurposed to treat substance use disorders because the drugs may target the effects of the newly discovered genetic signature associated with addiction. The list includes more than 100 drugs to investigate in future clinical trials, including those that can influence regulation of dopamine signaling.

The risk of developing substance use disorders is influenced by the complex interplay of genetics and environment. The investigators looked for variations in the genome that were closely associated with such disorders in many individuals across large sample sizes, including 1,025,550 people of European ancestry and 92,630 people of African ancestry. This type of genome-wide association study can identify key genetic variations that are associated with increased risk of having one or multiple disorders.

Hatoum and his team found that the genetic variation underlying addiction includes 19 single letter differences in the DNA code that were significantly associated with general addiction risk, which could inform development of universal therapies for multiple addictions. It also includes 47 genetic variants linked to specific substance disorders — nine for alcohol, 32 for tobacco, five for cannabis and one for opioids. Such information could point to novel treatments for addiction to individual substances. However, it is likely that many more genetic differences are actually involved in shaping a person’s genetic liability to one or more addictions.

Separately, the genomic analysis of individuals of African ancestry showed only one genetic variation associated with general addiction risk and one substance-specific variation for risk of alcohol use disorder. The smaller sample size may be one reason for the more limited findings in this population. Hatoum emphasized the need for data collection on substance use disorders in even larger and more diverse ancestral populations to tease apart whether these associations are universal or vary across ancestries. 

The genetic signature associated with increased risk of multiple substance use disorders also was linked to an increased likelihood of developing other health problems, including bipolar disorder, suicidal behavior, respiratory disease, heart disease and chronic pain. To serve as a control group for exposure to addictive substances, genetic data from over 4,500 9- and 10-year-old children of European ancestry who are participating in the national Adolescent Brain Cognitive Development Study — who presumably have not yet used addictive substances — were analyzed. The researchers found that children with the genetic signature for addiction were more likely to be related to someone who has a substance use disorder. The children also were more likely to show impulsive personality traits and disrupted sleep patterns, highlighting the possible role of these genes in early life behaviors, even before substance use occurs.

“This study could ultimately shift our conceptualization of addictive disorders, allowing novel pathways to research that will uncover more effective therapies for addiction,” Hatoum said.

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Newswise — (Boston)—Stigma negatively impacts the health of people with human immunodeficiency virus (HIV) and those with HIV who inject drugs experience stigma on multiple levels. Stigma leads to impaired utilization and retention in addiction treatment, less access to harm reduction services and reduces HIV care success. Unfortunately, there is a lack of interventions specifically targeting stigma related to HIV and substance use among people with HIV who inject drugs.

Now a new study from Boston University Chobanian & Avedisian School of Medicine has found that a brief stigma intervention that specifically targets people with HIV who inject drugs was effective in increasing engagement in substance use care as well as improving their ART adherence. The project was a US/Russia/Ukraine collaboration preceding the escalation of the war last year.

“Our findings reinforce that in settings where stigmatizing attitudes remain pervasive, stigma-coping interventions empowering affected people can attenuate stigma’s impact on substance use and HIV care,” explains corresponding author Karsten Lunze, MD, MPH, DrPH, associate professor of medicine.

The researchers engaged leading stigma intervention experts and community organizations in Russia and Ukraine and together developed anti-stigma group sessions. The group then recruited 100 participants with HIV and past-30-day injection drug use at community outreach buses run by a non-governmental harm reduction organization in St. Petersburg, Russia. The  study participants were randomized to receive either usual services only or an additional intervention of three weekly two-hour group sessions.

The researchers found that the intervention group participants had higher chances to start ART (20% vs 3% compared to the non-intervention) and engage with substance use treatment (23% compared to 7%).

According to the researchers, the increase in engagement might be due to the acceptance-based nature of the intervention, i.e., the reduction in avoidance of health care settings. “The intervention was not intended to directly reduce shame and fears related to internalized societal stigma, but was rather focused on improving stigma coping and thereby increasing healthy behavior and care seeking,” said lead author Jason Luoma, PhD, from the Portland Psychotherapy Clinic, Research, and Training Center.

These findings appear online in The Lancet Regional Health – Europe.

This research was supported by the National Institute on Drug Abuse (NIDA) under Grant R00DA041245 and Grant K99DA041245; and by the Providence/Boston Center for AIDS Research under Grant P30AI042853.

Newswise — Recently incarcerated people with opioid use disorder have trust in working with peer support specialists who recovered from addiction and faced similar life experiences, according to a Rutgers study.

The study, published in the journal Psychiatric Services, found that peer support specialists were most valued for providing emotional and community-based addiction recovery support as well as housing and employment information — crucial when going back into the community.

More than half of people incarcerated in state prisons have been diagnosed with a substance use disorder, according to the U.S. Department of Justice. They are most vulnerable in the months following their release, when they are at high risk of unemployment, homelessness, recidivism and overdose.

“The risk of a fatal drug overdose in the two weeks after release is 129 times that of the general population, in part because of the high risk of relapse and the loss of drug tolerance while incarcerated,” said Margaret Swarbrick, associate director of the Center of Alcohol & Substance Use Studies at Rutgers, research professor at the Graduate School of Applied and Professional Psychology and an author of the study.

The researchers interviewed 39 adult inmates diagnosed with an opioid use disorder who worked with peer support specialists upon their release from a New Jersey state prison between July 2020 and April 2021. Thirty completed a follow-up interview about four months later.

They found that participants appreciated working with someone with a shared life experience with whom they could establish a trusting relationship. However, they reported that policy barriers to recovery and community reintegration presented challenges to meeting certain needs, such as housing, food, employment and access to timely medical and recovery services, even with the peer navigator’s assistance.

Participants reported the peer support specialists were most valued for providing emotional support and housing and employment information and for navigating barriers to medical and community-based treatment. This was especially true for people with a conviction for drug distribution charges, which precludes access to resources for housing and employment, according to Michael Enich, an M.D.-Ph.D candidate at Rutgers Robert Wood Johnson Medical School, who reported on the findings.

“Studies have shown that trained peer support specialists who have experienced addiction, incarceration or both, who assist newly released offenders significantly improve the success rates of their reentry into society, especially when it comes to mental health treatment and sobriety,” said Enich. “However, few studies have examined the role of peer services for substance use disorders during the early months after prison release.”

Many participants viewed their peer navigators as role models who have overcome similar challenges, which was valued especially when they felt at risk of relapse, said Stephen Crystal, director of the Center for Health Services Research at Rutgers Institute for Health, Health Care Policy and Aging Research and an author of the study. “Having someone who was there for them ‘no matter what’ and whom they could call at any time was the most important aspect of the program as it gave them a sense of security,” said Crystal, who is also Board of Governors Professor at Rutgers School of Social Work.

The participants reported the most effective peer health navigators were empathetic, open-minded and good listeners.

The authors said more research is needed to rigorously examine the long-term impact of peer services on factors such as overdose reduction, treatment engagement and sustained recovery.

Other Rutgers researchers involved in the study are Peter Treitler, Leigh Belsky and Micah Hillis.

Newswise — Anthony DiStefano, professor of public health at Cal State Fullerton, believes that the sudden social isolation that occurred during the COVID-19 pandemic had an influence on mental health and drug overdose deaths.

Social isolation during the COVID-19 pandemic intensified feelings of stress, worry and hopelessness, leading some people to turn to drugs known for overdose risk, DiStefano said. The pandemic saw an increase in fatal drug overdoses, with most deaths caused by opioids — the majority of which were fentanyl, a synthetic opioid.

The opioid crisis began before COVID-19. Historically, issues in regulation and overprescribing of opioids caused major problems. More recently, limited access to medications prescribed to treat opioid use disorder — including methadone, buprenorphine and naltrexone — and a flooding of illegal drug networks with fentanyl have contributed to the crisis.

DiStefano said: “Some major causes appear to have been increased isolation and decreased access to treatment programs during the lockdowns; and increases in stress, depression and anxiety throughout the pandemic period.

“There have been many causes, but one focus in the public health literature since 2015 has been ‘deaths of despair,’ which include drug overdoses, suicides and alcohol-related liver mortality — largely linked to the cascading negative effects of socioeconomic disparities in affected populations.

“The degree to which these trends are continuing in 2023 is the subject of ongoing epidemiological surveillance. Additional research on the factors driving and constraining opioid overdose is occurring, and more is needed.”

Read more about DiStefano and the CSUF Department of Public Health.

About Cal State Fullerton: The largest university in the CSU and the only campus in Orange County, Cal State Fullerton offers 110 degree programs and Division 1 athletics. Recognized as a national model for supporting student success, CSUF excels with innovative, high-impact educational practices, including faculty-student collaborative research, study abroad and competitive internships. Our vibrant and diverse campus is a primary driver of workforce and economic development in the region. CSUF is a top public university known for its success in supporting first-generation and underrepresented students, and preparing all students to become leaders in the global marketplace. Our It Takes a Titan campaign, a five-year $250 million comprehensive fundraising initiative, prioritizes investments in academic innovation, student empowerment, campus transformation and community enrichment. Visit fullerton.edu.

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It’s sleep awareness week, according to the National Sleep Foundation. It’s important to understand how sleep deprivation can impact your health. Most people recognize that if they don’t get enough sleep, their mood and memory will suffer the next day. Scientists have studied how irregular sleep patterns affect our glymphatic system,  the waste management system that regulates toxins that can cause dementia and cognitive problems. Below are some of the latest headlines that have been added to the Sleep channel on Newswise.

March 17 World Sleep Day: Are You Getting Enough Sleep? Probably Not

#WorldSleepDay Sleep experts from University of Michigan Health available for interviews’

Not getting enough sleep could blunt antibody response to vaccination, leaving you more vulnerable to infection

Spanish physicists disagree with the Sleep Society and endorse the time change in the USA

Re-establish consistent sleep patterns to adjust to daylight saving time

Dim lights before bedtime to reduce risk of gestational diabetes

Trouble falling asleep at bedtime or in the middle of the night? It could impact your risk for developing dementia

Erratic sleep patterns linked to elevated blood pressure in teens with extra belly weight

Acid glia in REM sleep: Stronger acid response in epileptic mice

Sleep too much or too little and you might get sick more, scientists find

Impact of racism and inequities on African Americans’ sleep and well-being

Poor sleep exacerbates the development of multiple chronic diseases among Chinese and Korean Americans

Watch weekend tech as teens settle into school

Humans don’t hibernate, but we still need more winter sleep

Newswise — SPOKANE, Wash.—People living in the United States must travel significantly farther to access methadone treatment for opioid addiction than Canadians, suggests a new study led by Washington State University researchers.

Published in the journal Drug and Alcohol Dependence, the researchers’ analysis showed that the average driving distance to the closest methadone clinic accepting new patients was more than three times greater in the U.S. compared to Canada. When limiting their analysis to clinics that could provide treatment within 48 hours the difference was even larger, with those in the U.S. having to travel more than five times farther than their neighbors north of the border.

“Our research suggests that the U.S. could benefit from adopting Canada’s more flexible regulatory approach to methadone treatment, which is associated with greater availability of timely treatment, especially in rural areas,” said lead study author Ofer Amram, an assistant professor in the WSU Elson S. Floyd College of Medicine.

Amram explained that those seeking methadone treatment in the U.S. must start their treatment and receive their daily dose of methadone at federally approved treatment clinics, which in rural parts of the country can be far and few between. In Canada, methadone is prescribed not only in more widely available treatment clinics but also through trained primary care providers. Once treatment has started, Canadian patients can pick up their daily methadone dose at a local pharmacy.

The WSU team, who worked with researchers at Yale University and Simon Fraser University in Canada on the study, analyzed data collected from 563 methadone clinics accepting Medicaid or provincial insurance. These clinics were located in 14 U.S. states and three Canadian provinces that had the highest opioid overdose rates within each country. The researchers calculated the driving distance from 17,611 census tracts within those states and provinces to the nearest clinic accepting new patients. After adjusting for differences in population density and demographics, they found that U.S. census tracts were an average of 11.6 miles farther from the closest methadone clinic accepting new patients. For clinics that could take in new patients within 48 hours, the distance gap was even wider at an average of 25.1 miles farther in the U.S. than in Canada.

For rural areas of the U.S. where the population is more spread out, the researchers found that access to a clinic providing treatment within 48 hours required lengthy drives of as many of 138 miles. Amram said this was especially true for rural areas of Tennessee, Kentucky and Missouri.

Amram noted that their comparison only looked at methadone treatment clinics—Canadian primary care providers prescribing methadone were not included.

“What that tells us is that the actual differences in treatment accessibility between the U.S. and Canada are even larger than our study suggests,” he said.

Data for the study were collected between mid-May and mid-June 2020, when both the U.S. and Canada had COVID-19 related policy exemptions in place that temporarily increased access to take-home methadone doses to facilitate social distancing. A previous study led by the WSU investigators showed that this increased flexibility in take-home dosing did not lead to worse treatment outcomes. The study was cited in recent guidance issued by the U.S. Substance Abuse and Mental Health Services Administration that extends methadone take-home flexibilities for one year past the end of the COVID-19 Public Health Emergency, which is set to expire on May 11.

“Our work adds to a growing body of evidence that suggests that better outcomes may be achieved by making these changes permanent along with expanding treatment to additional outpatient settings such as primary care clinics and community pharmacies,” Amram said. “Given the magnitude of the opioid overdose crisis, it’s important that we consider all the tools available to us to reduce barriers to treatment.”