Category: From Newswise – Substance Abuse

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To read the letter, click here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3,800 students involved

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

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

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

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

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

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

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

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

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

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

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

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

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

Topics for Discussion:

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

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BYLINE: Leah Shaffer

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

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

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

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

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

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

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

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

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

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

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

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

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol conditions, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357). 

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

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

BYLINE: Tongyue Zhang

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

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

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

Researchers at these centers study complex brain disorders:

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

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

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

Celebrating Faculty Excellence

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

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

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

Rochester, Minn. — People around the globe are living longer — but not necessarily healthier — lives, according to Mayo Clinic research. A study of 183 World Health Organization (WHO) member countries found those additional years of life are increasingly fraught with disease. This research by Andre Terzic, M.D., Ph.D., and Armin Garmany documents a widening gap between lifespan and healthspan. Their paper is published in JAMA Network Open.

“The data show that gains in longevity are not matched with equivalent advances in healthy longevity. Growing older often means more years of life burdened with disease,” says Dr. Terzic, senior author. “This research has important practice and policy implications by bringing attention to a growing threat to the quality of longevity and the need to close the healthspan-lifespan gap.”

Dr. Terzic is the Marriott Family Director, Comprehensive Cardiac Regenerative Medicine for the Mayo Clinic Center for Regenerative Biotherapeutics and Marriott Family Professor of Cardiovascular Research at Mayo Clinic.

Lifespan-healthspan gap largest in the U.S.

Life expectancy, or lifespan, increased from 79.2 to 80.7 years in women and from 74.1 to 76.3 years in men between 2000 and 2019, according to WHO estimates. Healthspan describes the number of years a person has lived a healthy, active, disease-free life. However, the number of years those people were living in good health did not correspondingly increase. The average global gap in lifespan versus healthspan was 9.6 years in 2019, the last year of available statistics. That represents a 13% increase since 2000.

The U.S. recorded the world’s highest average lifespan-health span divide, with Americans living 12.4 years on average with disability and sickness. This increase from 10.9 years in 2000 comes as the U.S. also reported the highest burden of chronic disease. Mental health, substance use disorders and musculoskeletal conditions were the key contributors to illness nationally.

In addition, the study found a 25% gender disparity worldwide. Across 183 surveyed countries, women experienced a 2.4-year larger gap in lifespan versus healthspan than men. Neurological, musculoskeletal, urinary and genital tract disorders contributed to extended years of poor health among women.

“The widening healthspan-lifespan gap globally points to the need for an accelerated pivot to proactive wellness-centric care systems,” says Armin Garmany, first author and an M.D./Ph.D. student in Mayo Clinic Alix School of Medicine and Mayo Clinic Graduate School of Biomedical Sciences. “Identifying contributors to the gap unique to each geography can help inform healthcare interventions specific to each country and region.”

Healthspan research

The Mayo Clinic research team studied statistics from the WHO Global Health Observatory. This cross-sectional study provided data on life expectancy, health-adjusted life expectancy, years lived with disease and years of life lost among member states. The healthspan-lifespan gap for each member state was calculated by subtracting health-adjusted life expectancy from life expectancy.

The research team recommends additional exploration of demographic, health and economic characteristics to better define the disease patterns that are shaping the lifespan-healthspan disparities. Funding for the paper was provided by the Marriott Family Foundation, National Institutes of Health and National Institute of General Medical Sciences.

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