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Newswise — Lisa Fucito, PhD, Associate Professor of Psychiatry at Yale School of Medicine, is lead investigator for the first-ever U.S. trial of varenicline for e-cigarette cessation. The results were published May 16 in the American Journal of Preventive Medicine.

“We had a 15% difference in quit rates, with those in the medication group having a quit rate of 45%,” Fucito says.

Varenicline, better known under the brand name Chantix, has been used successfully for smoking cessation, but Fucito says vaping addiction can pose a stiffer challenge.

“People can get to very high levels of nicotine exposure with these e-cigarette products, and they can use them near constantly throughout the day,” Fucito says. “So, the question we all have is, ‘Can any pharmacotherapy stand up to this challenge?’” 

Newswise — In recent data shared by the Centers for Disease Control and Prevention, overdose deaths involving opioids fell in 2023; it’s the first decrease the agency has reported in five years. While the decline is encouraging, experts are still concerned as more than 100,000 individuals in the United States died of drug overdose last year. Daniel Lasoff, MD, emergency medicine physician with UC San Diego Health is available to discuss the decrease in deaths, as well as provide information on measures in place to treat opioid addiction and prevent overdose.

Biography :

Daniel Lasoff, MD, is a board-certified emergency medicine physician who treats patients of all ages, including those with life-threatening or critical conditions, at UC San Diego Health Emergency Departments in Hillcrest and La Jolla.

As an assistant professor at UC San Diego School of Medicine, Lasoff trains medical students, residents and fellows in the Department of Emergency Medicine, where he serves as medical director of the medical toxicology fellowship program. His research interests include drugs of abuse and resuscitation.

Newswise — CHAPEL HILL, NC – Unregulated use of fentanyl and overdose deaths have increased dramatically in recent years, and this trend was made more alarming when authorities found fentanyl laced with the animal tranquilizer xylazine. Some addiction specialists and public health officials feared the added xylazine would impede the fast-acting effects of the drug naloxone, which can effectively treat patients experiencing respiratory depression – a serious side effect of opioid use that can lead to death.

In a recent research discovery published in the journal Addiction Neuroscience, scientists at the University of North Carolina at Chapel Hill found that xylazine is a kappa opioid receptor agonist, meaning it activates kappa opioid receptors in the same way fentanyl activates opioid receptors. This result was surprising because previously xylazine was thought to only bind to the α₂-adrenergic receptor, and this finding could hint as to why withdrawal from fentanyl in combination with xylazine is so severe.

This research, led by the lab of Zoe McElligott, PhD, associate professor of psychiatry and pharmacology at the UNC School of Medicine, provides important insights into the subtle cellular mechanisms underlying opioid use – especially in light of the added anesthetic xylazine to fentanyl – and naloxone, the leading treatment used to prevent death from fentanyl overdose. She is senior author of the Addiction Neuroscience paper.

“Many people thought xylazine operated exclusively through a different mechanism in the nervous system,” said McElligott, who is also a member of the UNC Bowles Center for Alcohol Studies. “But because we show xylazine is an agonist at kappa opioid receptors in the brain and body, in addition to acting at other targets, we may have gleaned insight into why withdrawal from the combination of fentanyl and xylazine is so harsh.”

Because severe withdrawal results in extremely aversive symptoms, people often choose to continue using drugs to keep the physical and psychological effects of withdrawal at bay, according to McElligott. Her lab’s discovery, accomplished in collaboration with other researchers at UNC-Chapel Hill, could have big implications for future scheduling recommendations for xylazine and how clinicians might treat patients in the future.

“A big ‘take-home’ message is that we want to make sure people are administered naloxone as a life-saving treatment,” McElligott said. “When xylazine first came on the scene, there was a lot of talk about how it wouldn’t respond to naloxone. Our data suggest otherwise, and we don’t want people to not administer naloxone because they suspect someone has xylazine in their system.”

McElligott’s lab began its study when UNC Pharmacology graduate student Madigan Bedard poked her head into McElligott’s office on January 4, 2023, when no one else was in the lab. Bedard, who is the co-first author on this paper, asked if McElligott had heard that people had been using xylazine in combination with fentanyl.

“I was blown away because xylazine is what many scientists use to anesthetize animals for lab experiments usually in combination with ketamine, and large and small animal veterinarians use it as a sedative as well,” McElligott said. “We were interested because early on we read case reports that withdrawal from fentanyl/xylazine is particularly bad, and we study the effects of withdrawal, how withdrawal changes brain circuits and promotes the continued use of drugs and alcohol. So, we were curious what was going on here.”

First, they set up a strategic dosing experiment to study withdrawal in mice that received saline as a control, or fentanyl, fentanyl/xylazine. To be extra rigorous, Bedard set up an additional control looking at xylazine alone.

“We thought xylazine alone would be a second control,” McElligott said. “We thought those mice would react like the mice given saline.” When the saline mice got naloxone, there were very minor withdrawal symptoms, hinting at the role that endogenous opioids play in the brain. “But when the xylazine mice were treated with naloxone, we saw major withdrawal symptoms, akin to what we observed in mice treated with fentanyl, especially in female mice,” she said. “In the female mice, and at these doses, fentanyl and xylazine synergized to make withdrawal worse than either drug alone. Immediately, we knew something strange was going on here.”

McElligott and Bedard began thinking through the possibilities. Xylazine is known to target α₂– adrenergic receptors throughout the nervous system, and so they thought maybe naloxone was somehow bumping xylazine off those receptors to promote withdrawal. That seemed unlikely, she said, and they performed experiments with an α₂-adrenergic receptor inhibitor that did not resemble what they saw with naloxone. They thought xylazine might somehow increase the opioid tone of the brain through naturally occurring endogenous opioid peptides in the brain, such as endorphins. Or, they thought maybe xylazine is just a dirty drug, one that unintentionally binds to different kinds of brain receptors.

“Well, we’re in pharmacology at UNC,” McElligott said, “so we thought we’d ask a colleague for help.” They turned to Bryan L. Roth, MD, PhD, the Michael Hooker Distinguished Professor of Pharmacology who runs the NIH Psychoactive Drug Screening Program from his lab at the UNC School of Medicine. He holds a joint appointment at the UNC Eshelman School of Pharmacy. His team ran a rapid screen to see what receptors xylazine might target. A week later, Roth showed them the data. The drug latches on to kappa opioid receptors.

“That was not what we expected,” McElligott said, “We were very excited, but we didn’t want to hang all our data on that one screen.”

Roth’s lab wound up running a full profile on xylazine, including a slew of assays to be sure xylazine was activating kappa opioid receptors in addition to adrenergic receptors. It was.

Thanks to funding from the National Institute of Drug Abuse/NIH and the  FDA-awarded Triangle Center of Excellence in Regulatory Science and Innovation (Triangle CERSI) at the UNC Eshelman School of Pharmacy, McElligott’s lab ran further experiments to produce more data in mouse models for the effects of naloxone and another drug called norbinaltorphimine, also known as nor-BNI, with pretreatment of mice surprisingly made withdrawal worse in the xylazine mice that had been later treated with naloxone. These effects were more profound in female mice. This, too, adds another layer of evidence; kappa opioid receptors behave differently in male and female mice.

“We have lots of tantalizing early data in this paper, and we have so much to follow up on,” McElligott said. “But we think our work suggests scientists and clinicians need to investigate different strategies for mitigating some of the withdrawal responses we are now seeing in individuals, especially those exposed to fentanyl laced with xylazine. Additionally, we’ve begun to collaborate with Nabarun Dasgupta at UNC’s Injury Prevention Research Center at the UNC Gillings School of Global Public Health. Nab runs UNC’s Street Drug Analysis Lab and is the best source for understanding the current landscape of the unregulated drug supply. By collaborating with Nab and his team, we hope to be equipped to rapidly adapt our research for the next unexpected adulterant to the drug supply.”

The unapproved use of xylazine in humans not only poses challenges for scientific and clinical understanding of the drug, especially in combination with other drugs, but also for law enforcement, first responders and treatment facilities, who work daily to navigate the adverse effects of the unregulated drug supply.

Christin Daniels, PhD, Executive Director of the Triangle CERSI, said, “The research being conducted in the McElligott Lab at UNC is of timely importance to legislators and regulatory agencies, such as the FDA, in their continued efforts to combat America’s opioid epidemic. Until we have more data on the pharmacology, addictive properties and physiological effects, decisions about how to regulate xylazine are pending.”

Co-first author of the Addiction Neuroscience paper is Xi-Ping Huang, PhD, assistant professor in the Roth Lab. Other authors are research technician Jackson G. Murray, postdoctoral fellow Alexandra C. Nowlan, PhD, graduate students Sara Y. Conley and Sara E. Mott, all in the McElligott lab at the time of investigation; UNC undergraduate researchers Samuel J. Loyack, Calista A. Cline, and Caroline G. Clodfelter; Brian Krumm, PhD, an assistant professor in the Roth Lab; and Nabarun Dasgupta, PhD, MPH, senior scientist at the UNC Injury Prevention Research Center and the first Innovation Fellow at the UNC Gillings School of Global Public Health.

BYLINE: Yadira Galindo

Newswise — A defining development of the 20th century that changed the course of public health was when governments around the world improved access to safe water, sanitation and hygiene. However, a binational study led by University of California San Diego researchers found that, during the peak of the COVID-19 pandemic, people experiencing homelessness and individuals who inject drugs in San Diego and the bordering city of Tijuana, Mexico often did not have access to these basic resources.

There are estimated to be 10,000 people who inject drugs in Tijuana and another 21,800 in San Diego, many of whom are experiencing homelessness.

Reporting in the International Journal for Equity in Health, study first author Alhelí Calderón Villarreal, M.D., M.P.H., who conducted the research as part of her doctoral dissertation as a student in the UC San Diego-San Diego State University Joint Doctoral Program in Public Health, wrote that access to water, sanitation and hygiene was very low by international standards, and lower than the national averages in the United States and Mexico, for people who inject drugs and live in San Diego and Tijuana.

“We found that even in Southern California — one of the wealthiest parts of the world — people who use drugs often go without access to water, showers and toilets. The lack of these basic services also places people who use drugs at risk of serious, but preventable, illnesses, and poses risks to society at large,” said Calderón Villarreal, who will graduate in June with a Doctor of Philosophy in Public Health from the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego.

Researchers interviewed 586 people in Tijuana (202) and San Diego (384) between 2020 and 2021, when COVID-19 infection was highest and when having access to water, showers and toilets should have been a public health priority.

Researchers found that 78 percent of individuals interviewed did not have access to an acceptable toilet, 54 percent did not have regular access to showers, and 11 percent reported having insufficient access to drinking water. Only 38 percent of study participants had access to water and soap for handwashing and the same number of participants reported defecating outdoors, placing themselves and the general public at health risk.

Abscesses and vascular damage are common injuries among people who inject drugs. Unsafe water used for preparing drugs or cleaning wounds can lead to life-threatening health problems including the risk of viral, parasitic and bacterial infections which include multi-drug resistant organisms, said the study authors.

Twenty percent of study participants said they felt thirsty daily, without access to drinking water. In fact, nearly all participants – 96.9 percent – drank less water daily than is medically recommended for proper hydration.

“Access to water, sanitation and hygiene are needed in both cities to reduce disparities and improve health and well-being among people who inject drugs, especially for those who are unhoused. It also benefits public health for the region as a whole,” said senior author Georgia Kayser, Ph.D., assistant professor at the Herbert Wertheim School of Public Health.

Experiencing homelessness increased the difficulty of finding toilets, bathing facilities and clean water sources. This was made even more difficult if the individual was unsheltered or on the street. Compared to participants who had housing, those who were unsheltered were 3.1 times more likely to be unable to access clean water sources for cleansing wounds and abscesses and 2.6 for preparing drugs for injection. They were twice as likely to be unable to access basic drinking water, 1.8 times more unlikely to have bathing opportunities, and 1.7 times less likely to have access to sanitation.

Participants residing in Tijuana reported a lack of access to basic drinking water and body and hand hygiene significantly more often than those living in San Diego. In Tijuana, 30 percent of people had access to basic hygiene (handwashing with water and soap) and 37 percent to bathing compared to 47 percent and 50 percent respectively in San Diego.

While San Diego provides more public access to water, sanitation and hygiene services, both cities have similar challenges and therefore can implement similar solutions.

The study authors suggest two solutions. Ideally, provide safe and secure places to live with access to safe water and sanitation to improve overall health and wellbeing. In the interim, expand access to mobile hygiene services and public restrooms, for those who do not have a traditional housing setting. This could involve extending hours of operation for existing public facilities, creating more public restrooms, increasing the number of mobile water, sanitation and hygiene service providers, and the integration of showers and toilet facilities in harm reduction programs.

“Providing everyone with access to drinking water, sanitation and hygiene services is necessary to prevent disease transmission and improve public health in the region,” said Gudelia Rangel, Ph.D., professor and investigator at the Colegio de la Frontera Norte and Border Health Coalition, Baja California, Mexico.

Co-authors include: Lourdes Johanna Avelar Portillo, UC San Francisco; Daniela Abramovitz, UC San Diego; Shira Goldenberg, Shawn Flanigan, Penelope J. E. Quintana, all of San Diego State University; Alicia Harvey‑Vera, UC San Diego and Universidad de Xochicalco; Carlos F. Vera, UC San Diego; and Steffanie Strathdee, principal investigator, UC San Diego School of Medicine.  

This research was funded, in part, by the National Institute of Drug Abuse (R01DA049644, 3R01DA04964403S2), National Council of Science and Technology (CONACYT) 2020 in Mexico, Fogarty International Center of the National Institutes of Health (D43TW009343), and the National Institute of Environmental Health Sciences (K01ES031697).

Disclosures: The authors report no conflicts of interest.

DOI: 10.1186/s12939-024-02163-x

Newswise — A growing number of states and territories in the United States have legalized medical and recreational cannabis use. As such, recreational cannabis has been associated with a lower perception of risk of harm in the general U.S. population.

However, in women of childbearing age, evidence has shown that cannabis use may increase the risk of adverse reproductive and perinatal health outcomes. Furthermore, research on the perception of risk from using cannabis among vulnerable populations such as those with disabilities is lacking.

Using data from the 2021 National Survey on Drug Use and Health, researchers from Florida Atlantic University’s Schmidt College of Medicine conducted a study to assess the perceived risk of harm associated with weekly cannabis use in a sample of 20,234 women ages 18 to 49 by disability status.

Disabilities included sensory (hearing and vision), cognitive (difficulty remembering and concentrating) and daily activities (e.g., walking and self-care). Researchers included race/ethnicity, age, marital status, federal poverty level, past-year health insurance gap, and whether the state of residence legalized medical cannabis. They also assessed perceived overall health status, past-year major depressive episode, past-month tobacco/alcohol use, and illicit drug use.

Results of the study, published in the journal Cannabis and Cannabinoid Research, showed that approximately 60% of women with disabilities who used cannabis in the past 12 months perceived no risk of harm from weekly cannabis use. A significantly higher percentage of women with any disability perceived no risk associated with weekly cannabis use (37.9%) compared to those with no disabilities (26.1%).

More than one-quarter (27.4%) of women perceived no risk of harm associated with weekly cannabis use. Overall, perceiving no risk associated with weekly cannabis use was evident among women ages 21 to 29 (34.4%), those who were never married (32%), were non-Hispanic Black (32.2%), living in poverty (31%), perceiving their health as fair/poor (35.1%), and experienced a past 12-month major depressive episode (36.4%). The likelihood of perceiving no risk also was higher among women using tobacco and those using both alcohol and tobacco.

“Given women’s attitudes toward cannabis as a harmless drug, the increasing rates of its use among those with disabilities, and the potential adverse health outcomes, it is imperative to monitor and understand perceptions of risk of harm from cannabis use among women with disabilities,” said Panagiota “Yiota” Kitsantas, Ph.D., senior author, professor and chair, Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. 

Overall, women with disabilities and cannabis use in the past 12 months had 2.9 times higher odds of perceiving no risk associated with weekly use of cannabis compared to women without any disability and no cannabis use. The odds also were higher for those who did not have a disability but used cannabis in the past year, which indicates that cannabis exposure, in general, may increase a woman’s likelihood of not perceiving any harm to her health from weekly use.

Exposure to cannabis use during pregnancy has been associated with adverse birth outcomes including low birth weight, preterm delivery, small for gestational age, admission to the neonatal intensive care unit and infant death. Cannabis use also may affect sex hormones essential to fertility and the timing of ovulation in reproductive age. 

“As legalization of cannabis use becomes more prevalent across states, attitudes regarding the risk of cannabis use are changing,” said Lea Sacca, Ph.D., co-author and an assistant professor in the Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. “A multi-pronged approach to address cannabis use among vulnerable populations such as women of childbearing age with disabilities will require clinical guidance, provider and patient education and evidence-based public health programs.”

Although research evidence shows that residents in states where cannabis is legal are more likely to believe that cannabis has benefits than those living in states with just medically legal cannabis or nonlegal states, this study suggests that living in a state that has legalized medical cannabis was associated with a decreased likelihood of perceiving no risk from using weekly cannabis relative to states with no legalized use of medical cannabis.

“There is an urgent need for effective cannabis screening and subsequent dissuasion of cannabis use for reproductive-aged women at risk of substance use. Obstetrician-gynecologists can play an important role by informing patients about healthy behaviors and encouraging long-term adoption as well as identifying patients abusing drugs for proper referral to addiction treatment professionals,” said Kitsantas. “Importantly, health policies should include holistic programs to proactively educate the population, pharmacists, medical and public health professionals of the associated benefits and risks of cannabis use among reproductive-aged women with disabilities.”

Study co-author is Salman M. Aljoudi, a health data analyst, a Ph.D. researcher and an instructor at George Mason University. 

– FAU –

About the Charles E. Schmidt College of Medicine:

FAU’s Charles E. Schmidt College of Medicine is one of approximately 157 accredited medical schools in the U.S. The college was launched in 2010, when the Florida Board of Governors made a landmark decision authorizing FAU to award the M.D. degree. After receiving approval from the Florida legislature and the governor, it became the 134th allopathic medical school in North America. With more than 70 full and part-time faculty and more than 1,300 affiliate faculty, the college matriculates 64 medical students each year and has been nationally recognized for its innovative curriculum. To further FAU’s commitment to increase much needed medical residency positions in Palm Beach County and to ensure that the region will continue to have an adequate and well-trained physician workforce, the FAU Charles E. Schmidt College of Medicine Consortium for Graduate Medical Education (GME) was formed in fall 2011 with five leading hospitals in Palm Beach County. The Consortium currently has five Accreditation Council for Graduate Medical Education (ACGME) accredited residencies including internal medicine, surgery, emergency medicine, psychiatry, and neurology.

About Florida Atlantic University: Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.fau.edu.

Newswise — Supplementing standard opioid addiction treatment with Mindfulness Oriented Recovery Enhancement (MORE) — an intervention that incorporates mindfulness training, savoring skills, and cognitive reappraisal — cuts program dropout rates by 59 percent and relapses by 42 percent, according to Rutgers-led research.

These trial results come from Rutgers Health amid unprecedented opioid abuse. An estimated 10 million Americans misuse opioids or have opioid use disorder, while annual overdose deaths have exceeded 80,000.

Treatment with methadone or buprenorphine – alone or in combination with cognitive behavioral therapy – is imperfect. Half of all people drop out of treatment within a year, and half of all people who continue treatment keep using opioids.

“Better treatment protocols could save thousands of lives per year, and the data we have from our pilot study and this phase II trial suggest mindfulness training may create a genuinely better treatment protocol,” said Nina Cooperman, an associate professor of psychiatry at Rutgers Robert Wood Johnson Medical School and first author of the study published in JAMA Psychiatry.

Mindfulness training teaches people to focus on the present moment, without judgment, and on sensory inputs such as the feeling of breathing in and out. Previous studies demonstrating that such training can prevent addiction to opioid pain medication led Cooperman’s team to ask whether similar techniques could help people who already have an opioid use disorder.

A small pilot study found that mindfulness training combined with methadone treatment produced good outcomes. The pilot’s success paved the way for this larger study, which, in turn, has justified two large-scale studies that could change standards of care.

The current trial provided eight two-hour sessions to 77 of 154 patients in methadone treatment for opioid use disorder.

“Opioid use disorder changes your brain so that opioid use becomes the only thing that feels rewarding. MORE helps people retrain themselves to find healthy experiences rewarding again by focusing mindfully on the taste of a meal, the beauty of a landscape or the smell of a flower,” said Cooperman, who added the program literally includes observing and smelling roses during sessions.

Mindfulness training also gives people another tool for handling cravings.

“Cognitive behavioral therapy, which is common in treatment programs, teaches people to reframe their thoughts and distract themselves from cravings,” Cooperman said. “Mindfulness training teaches them to stay present with the craving and notice that they pass. Both strategies can work, so both are valuable.”

The success of mindfulness training in Cooperman’s study may stem from its ability to help patients manage pain. Most patients began the study with significant chronic pain — and, thus, a strong incentive to use pain-killing opioids — but patients who received MORE reported a 10 percent reduction in pain over the 16 weeks of the study.

Looking forward, Cooperman and her team are working on larger studies, which are designed to provide further evidence for the efficacy of MORE and to optimize protocols for use in the real world.

“We still have lots of open questions. How can we train clinicians to implement MORE in treatment programs? What is the best structure for implementing MORE—in-person or virtual? Our current research is working to answer some of these questions,” Cooperman said. “The findings from this study suggest MORE really can improve outcomes for a lot of people in substance abuse treatment.”

Newswise — HOUSTON ― For most smokers, quitting on the first attempt is likely to be unsuccessful, but a new study from The University of Texas MD Anderson Cancer Center found patients were more likely to quit if their cessation regimen was altered and doses were increased. Researchers also found that varenicline, a cessation medication, was more effective than combined nicotine replacement therapy (CNRT), such as patches or lozenges.

The study, published today in JAMA, revealed smokers who failed to quit with varenicline in the trial’s first phase were seven times more likely to quit by the end of the second phase if varenicline doses were increased. There also was a nearly two-fold increase in those who successfully quit if they were switched from a CNRT regimen to varenicline. These results are favorable compared to the near zero chance of abstinence seen in patients who were switched from varenicline to CRNT or left on the same treatment plans.

“These data indicate that sticking to the same medication isn’t effective for smokers who are unable to quit in the first six weeks of treatment,” said lead researcher Paul Cinciripini, Ph.D., chair of Behavioral Science. “Our study should encourage doctors to check in on patients early in their cessation journey and, if patients are struggling, to try a new approach, such as increasing medication dosage.”

The double-blind, placebo-controlled trial followed 490 smokers who were randomized to receive six weeks of varenicline or CNRT. After the first phase, those unable to quit were re-randomized to continue, switch or increase medication dose for an additional six weeks. Initial treatment included 2 mg of varenicline or CNRT (21 mg patch plus 2 mg lozenge). Participants who were re-randomized either continued the same varenicline or CNRT dose, switched between varenicline and CNRT, or were given an increased dose of 3 mg of varenicline or CNRT (42 mg patch plus 2 mg lozenge). The study was conducted in Texas from June 2015 to October 2019.

Of the patients who received varenicline and had their doses increased, 20% were still abstaining six weeks later. Meanwhile, the abstinence rate was 14% among patients who switched from CRNT to varenicline or who had their CRNT doses increased. However, varenicline patients who switched to CNRT saw a 0% quit rate. After six months, only those who had their doses increased remained continuously abstinent.

Tobacco use remains the leading preventable cause of death and disease in the U.S. Each year, about 480,000 Americans die from tobacco-related illnesses. Currently, more than 16 million Americans suffer from at least one disease caused by smoking, including cancer. Quitting tobacco can improve the chances of survival by 30-40% for cancer patients who smoke. Since the average smoker makes several attempts to quit before successfully beating the addiction, MD Anderson tackles the barriers to cessation at an individual and population level, factoring in cost, access to cessation services, and knowledge gaps among health care providers on treating tobacco addiction.

In a larger ongoing trial, researchers are testing several different medication combinations as an alternative for those unable to quit on their initial doses of varenicline or CNRT.

The research was supported by the Cancer Prevention and Research Institute of Texas (CPRIT) (RP150228), MD Anderson’s Lung Cancer Moon Shot^®, the National Cancer Institute (P30CA016672), and the State of Texas Permanent Health Funds awarded to MD Anderson. Varenicline and matching placebo were provided by Pfizer Pharmaceuticals (WI192533). CRNT products and matching placebo were purchased from NAL Pharma. A full list of collaborating authors and their disclosures can be found here.

Newswise — New York, NY (April 29, 2024) – Opioid (including heroin) overdose-related deaths continue to increase at staggering rates among adults in the United States. Inhibitory control – the ability to suppress unwanted behaviors, such as drug use, despite substantial negative consequences and a desire to quit – is impaired in individuals with drug addiction and is accompanied by functional deactivations in the prefrontal cortex (PFC), a brain region that subserves self-control processes.

In line with their previous work, researchers from the Icahn School of Medicine at Mount Sinai showed that individuals with heroin use disorder have lower activity in the anterior and dorsolateral PFC when performing an inhibitory control task compared with healthy controls. Importantly, they revealed that 15 weeks of medication-assisted therapy, which included supplemental group therapy, improves impaired function of the anterior and dorsolateral PFC during an inhibitory control task among the group of participants with heroin use disorder, suggesting a time-dependent recovery of inhibitory control and PFC function in individuals with heroin use disorder after such a treatment intervention. 

Specifically, 26 inpatient individuals with heroin use disorder undergoing medication-assisted treatment and 24 demographically-matched healthy controls were recruited for a longitudinal task-based functional MRI (fMRI) study. Participants attended two fMRI sessions, separated by 15 weeks of medication-assisted inpatient treatment for individuals with heroin use disorder and a comparable time interval for healthy controls. During fMRI, the study participants performed a stop-signal task – a well-validated tool for estimating brain function during inhibitory control behavior. During the task, study participants responded to directional arrow stimuli and withheld their responses when the arrow occasionally turned red (the stop signal). In addition to showing increased activity in the PFC regions after 15 weeks of inpatient treatment, the increased activity correlated with better behavioral performance in the stop-signal task by individuals with heroin use disorder.

“Overall, our findings identify the anterior and dorsolateral PFC regions as potentially amenable to targeted interventions to potentially expedite their recovery during inhibitory control, which may have translational value to help inform future treatment methods,” says Ahmet O. Ceceli, PhD, senior postdoctoral fellow and lead author of the paper.

“More research is needed to determine if there is a specific aspect of inpatient treatment that substantially contributes to the improvement and to examine other specific factors. For example, our research team plans to test whether the recovery effects we observed in this study are attributable to the mindfulness-based intervention that was part of the supplemental group therapy intervention” says Rita Z. Goldstein, PhD, Professor of Psychiatry and Neuroscience at Icahn Mount Sinai and senior author of the paper.

To learn more about this study, please visit: https://www.nature.com/articles/s44220-024-00230-4

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