Category: From Newswise – Substance Abuse

Newswise — For some people receiving methadone for treatment of opioid use disorder (OUD), the co-use of opioids and stimulants such as cocaine is an issue. Now, a new study led by Johns Hopkins Medicine researchers found that bupropion, an antidepressant medication also used for smoking cessation, may help people stop using cocaine while in treatment for OUD.

The results of the study were published March 15 in JAMA Network Open.

For this double-blind randomized study, the researchers used an adaptive treatment design, meaning that it allowed modifications to the trial and its statistical procedures. Between March 2015 and September 2019, 80 adult participants who were receiving methadone for OUD were recruited. Participants self-reported using cocaine at least once in the 30 days prior to entering the study. Their average age was 48 and they were predominately male (66%). Forty participants were randomized to receive bupropion (up to 300 mg twice daily, orally) while the other 40 received a placebo. The participants were seen three times each week for 30 weeks. Urine samples and data on self-reported cocaine use were collected during every visit. Subjects received a monetary incentive for providing cocaine-negative urine samples during the study’s first 26 weeks. Monetary incentives began at 50 cents per negative urine sample and increased exponentially throughout the course of the study. Nothing was earned for positive samples.

“Cocaine use is something our patients receiving methadone report wanting help with, and until now, very few treatments have been successful at helping them stop using cocaine,” says Kelly Dunn, Ph.D., M.B.A., professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “Providing a monetary incentive is one of the most effective treatment strategies for cocaine use disorder.”

Importantly, the type of incentive participants received varied based on their treatment response during the first six weeks of the study. Subjects who stopped using cocaine during the first six weeks received incentives to prevent relapse, while those who did not stop using cocaine received enhanced incentives to promote abstinence. Following this period, participants were assigned to receive either the medication or placebo for the remainder of the study. To determine whether the combined medication and incentive treatment was effective, the study compared people receiving either medication or placebo overall and then again within the two incentive groups.

The study did not find an effect of bupropion versus placebo overall. However, among participants who earned monetary incentives to help them stop using cocaine, those who received bupropion were more likely to not be using cocaine at the end of the study (67%) compared with those who received abstinent incentives with the placebo (30%). In contrast, people who received incentives designed to prevent relapse did not have any additional benefit from receiving bupropion versus placebo.

“Pairing bupropion to prevent cocaine use after the monetary incentives are discontinued may be a promising treatment strategy,” says Dunn. “Our study showed that bupropion can work for a subgroup of people with OUD, and that whether or not they respond initially to treatment is a meaningful determinant as to the intensity of treatment they might need going forward.”

The researchers say more studies are needed to assess the long-term outcomes for these patients and to see at what rate they might relapse back to cocaine use.

“We want to know the optimal length of time people need to be exposed to the medication to make the abstinence effects last longer,” says Dunn.

Dunn is available for interviews.

Newswise — March 14, 2023– The COVID-19 pandemic has had a long-lasting impact on adolescent mental health and substance use according to a new population-based study are based on survey responses from a nationwide sample of over 64,000 13–18-year-old North American and Icelandic adolescents assessed prior to and up to two years into the pandemic. The study was conducted by faculty at Columbia University Teachers College and Mailman School of Public Health and a team of Icelandic and other North American clinical, behavioral and social scientists. The findings are published in published in The Lancet Child & Adolescent Health.

This same research team published a population-based study in The Lancet Psychiatry in 2021 showing an increase in depressive symptoms and decrease in mental well-being among 13–18-year-old adolescents within one year of the global spread of the COVID-19 pandemic. A decline in substance use, in particular cigarette smoking, e-cigarette use and alcohol intoxication, was also observed. Expanding on these findings, this new study shows that the negative effect on adolescent mental health has been persisted up to two years into the pandemic.

“It is worrisome that we still see an increase in mental health problems among adolescents two years into the pandemic. And this is occurring despite social restrictions having been eased in Iceland,” said Thorhildur Halldorsdottir, assistant professor of psychology at Reykjavik University and senior author of the study.

The initial decrease in cigarette smoking and e-cigarette use observed shortly after the arrival of the pandemic was also maintained up to two years into the pandemic. The frequency of adolescent alcohol intoxication, however, appeared to be returning to pre-pandemic levels. “It is of course positive to see that the reduction in cigarette smoking and vaping has been maintained,” said Dr. Ingibjorg Eva Thorisdottir, chief data analyst at Planet Youth and lead author of the study. She continued: “We will need to monitor alcohol intoxication among adolescents in years to come, especially given the increase in mental health problems.”

The association of immigration status, residency, parental social support and nightly sleep duration with adolescent mental health and substance use was also examined in this study. Parental social support and an average of 8 hours or more of sleep per night was associated with better mental health and less substance use among adolescents. The relationship between immigration status and residency with adolescent mental health was less clear. These findings suggest that stress exposure, like the COVID-19 pandemic, affects all adolescents to some extent rather than only vulnerable subgroups.

As such, policy makers should consider implementing large-scale evidence-based prevention efforts focusing on depressive symptoms to mitigate the negative effect of the pandemic,” said John Allegrante, the Charles Irwin Lambert Professor of Health Behavior and Education at Teachers College and professor of sociomedical sciences at Columbia Mailman School of Public Health, and a senior collaborating investigator on the study.

The research was supported by the Icelandic Research Fund.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

Newswise — Philadelphia, March 14, 2023 – Hypnosis is an effective treatment for pain for many individuals but determining which patients will benefit most can be challenging. Hypnotizability testing requires special training and in-person evaluation rarely available in the clinical setting. Now, investigators have developed a fast, point-of-care molecular diagnostic test that identifies a subset of individuals who are most likely to benefit from hypnosis interventions for pain treatment. Their study, in The Journal of Molecular Diagnostics, published by Elsevier, also found that a subset of highly hypnotizable individuals may be more likely to experience high levels of postoperative pain.

“Since hypnotizability is a stable cognitive trait with a genetic basis, our goal was to create a molecular diagnostic tool for objectively identifying individuals who would benefit from hypnosis by determining ‘treatability’ at the point-of-care,” explained co-lead investigator Dana L. Cortade, a recently graduated PhD in Materials Science and Engineering, School of Engineering, Stanford University, Stanford, CA, USA. “The advancement of nonpharmacological adjuvant treatments for pain is of the utmost importance in light of the opioid epidemic.”

Prior research established that the genetic basis for hypnotizability includes four specific single-nucleotide polymorphisms (SNPs), or genetic variations, found in the catechol-o-methyltransferase (COMT) gene for an enzyme in the brain that is responsible for dopamine metabolism in the prefrontal cortex. Although SNPs can contain valuable information on disease risk and treatment response, widespread use in clinical practice is limited because of the complexities, costs, and time delays involved in sending samples to laboratories for testing.

The investigators developed a SNP genotyping assay on a giant magnetoresistive (GMR) biosensor array to detect the optimal combination of the COMT SNPs in patient DNA samples. GMR biosensor arrays are reliable, cheaper, sensitive, and can be easily deployed in point-of-care settings using saliva or blood samples.

The study investigated the association between COMT diplotypes and hypnotizability using a clinical hypnotizability scale called the Hypnotic Induction Profile (HIP) in individuals who had participated in one of the three previous clinical trials in which an HIP was administered. An additional exploratory study of the association between perioperative pain, COMT genotypes, and HIP scores was conducted with the patients in the third cohort, who had undergone total knee arthroplasty (TKA). DNA was extracted from blood samples previously collected in the first cohort, and saliva samples were collected by mail from participants in the other two trials. Participants were considered treatable by hypnosis if they had HIP scores of 3 or higher on a scale of zero to 10.

For participants identified with the optimal COMT diplotypes by the GMR biosensor array, 89.5% scored highly on the HIP, which identified 40.5% of the treatable population. The optimal COMT group mean HIP score was significantly higher than that in the suboptimal COMT group. Interestingly, further analysis revealed that the difference was observed only in women.

“Although we had expected some difference in effect between females and males, the association between hypnotizability and COMT genotypes was strongest in the females in the cohort,” said co-lead investigator Jessie Markovits, MD, Department of Internal Medicine, Stanford School of Medicine, Stanford, CA, USA. “The difference may be due to lower numbers of males in the cohort, or because COMT is known to have interactions with estrogen and to differ in activity by sex. Additional gene targets including COMT, with stratification by sex, could be the focus of future study.” 

In the exploratory analysis of the relationship between COMT genotypes and pain after TKA surgery, the same optimal COMT individuals had significantly higher postoperative pain scores than the suboptimal group, indicating a greater need for treatment. “This supports the body of evidence that COMT genotypes impact pain, and it is also known that COMT genotypes affect opioid use after surgery. Pain researchers can use this technology to correlate genetic predisposition to pain sensitivity and opioid use with response to an evidence-based, alternative remedy: hypnosis,” Dr. Cortade said.

COMT SNPs alone are not a complete biomarker for identifying all individuals who will score highly on a hypnotizability scale and experience high pain sensitivity. The GMR sensor nanoarray can accommodate up to 80 SNPs, and it is possible that other SNPs, such as those for dopamine receptors, are needed to further stratify individuals.

The investigators observe that this study highlights the utility and potential of the evolving applications of precision medicine. “It is a step towards enabling researchers and healthcare professionals to identify a subset of patients who are most likely to benefit from hypnotic analgesia,” Dr. Markovits said. “Precision medicine has made great strides in identifying differences in drug metabolism that can impact medication decisions for perioperative pain. We hope to provide similar precision in offering hypnosis as an effective, non-pharmacological treatment that can improve patient comfort while reducing opioid use.”

Large doses of opioids are commonly prescribed after total knee and hip arthroplasty to avoid call-ins for refills, but smaller doses can be just as effective.

New findings expand on previous research suggesting that Black newborns are more likely to be screened for prenatal drug exposure compared to other racial and ethnic groups, even in the absence of risk factors for substance use disorders.

A United States Food and Drug Administration mandate to limit the dosage of acetaminophen in pills that combine acetaminophen and opioid medications is significantly associated with subsequent reductions in serious liver injury.

Over the past 20 years, the death rate from drug poisonings in the U.S. has tripled and suicide and alcoholic liver disease death rates have increased by 30 percent — particularly among middle-aged white Americans. Daniel Hungerman, professor of economics at the University of Notre Dame, and his co-authors studied the connection between a sharp downturn of religious participation in the late 1980s and the swift rise in these “deaths of despair” among white Americans ages 45 to 54 in the early 1990s.

Adults with Alcohol Use Disorder (AUD) seeking to moderate their drinking respond differently to interventions depending on their age, a new study suggests.

Recommendations from research published today on the diagnosis and treatment of spinal cord damage caused by nitrous oxide abuse have been simultaneously adopted as official clinical practice guidelines by the Association of British Neurologists.