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Newswise — WASHINGTON, DC — A new editorial in the BMJ suggests that a 22% decrease in overall U.S. drug overdose deaths over 2023/2024 signals that investments in overdose prevention and substance use disorder treatment are working. In Avoiding a new US “war on drugs”: Declining US drug overdose deaths show that evidence-based public health approaches work (Vincent Guilamo-Ramos, Adam Benzekri, Loftin Wilson, and Marissa D. Abram), the authors call for more investment in treatment and prevention to accelerate progress — and to reject calls for a return to “War on Drugs” tactics that bipartisan experts believe didn’t work.

“Evidence-based prevention and treatment are working in communities across the entire country. There’s also a growing sense across the ideological divide that this is the smartest approach, while the ‘War on Drugs’ simply wasn’t — because it was law enforcement-focused, disproportionately harmed communities of color, was a waste of money, and it just didn’t work. In an era of increased appetite for criminalizing health and social problems, we have already learned that addiction is best addressed with care, not convictions.  Bottom line: a return to ‘War on Drugs’ tactics could reverse the progress made in the overdose crisis and make the situation much worse,” said Dr. Vincent Guilamo-Ramos, IPS Executive Director and the Leona B. Carpenter Chair in Health Equity and Social Determinants of Health at Johns Hopkins School of Nursing. 

The editorial explores what is most likely driving the welcome decline in deaths – and why in some states overdoses are rising. It looks at how more “tough on crime” messaging could lead to a more law enforcement-driven response to drug taking and overdoses – pushing back progress, especially in communities of color where the decline has been slower. It explores existing prevention and treatment successes – such as major changes in opioid medication prescription policies and practices, expanded access to opioid use disorder medications, and the scaling-up of community-based harm reduction services. Finally, it notes promising new strategies to further eliminate substance related prevention and treatment inequities such as: community and family-based models of prevention and treatment service delivery in marginalised communities and achieving a health workforce more representative of the populations served.

“Making the right call at this moment-of-opportunity is key to save and improve more lives. The wrong call is for approaches that are ineffective and unjust; this would fail all US communities — especially those in which overdose deaths continue to rise. It’s time to get tougher FOR prevention and treatment, for MORE targeted investment in prevention and treatment – and not to repeat the mistakes of the past,” Guilamo-Ramos stressed. 

ENDS

Notes to editors

A: Overdose Death Rate per 100,000 (age-adjusted)

B: Number of Overdose Deaths

More on IPS

The Institute for Policy Solutions (IPS) at Johns Hopkins School of Nursing ends health inequities through evidence-based policy solutions. IPS is focused on nurse-driven solutions to solve one of the country’s most alarming and unsustainable problems: health inequities. Nurses bring novel solutions to health system reform that optimize health for all — no matter who you are or where you live. Our expertise and insight into the systems that deliver care and impact health, as well as what matters to patients, families, and communities, uniquely position the nursing profession to transform health care delivery to prioritize health and well-being. Through nurse leadership, the Institute drives collaborations with interdisciplinary and cross-sectoral partners in dialogue, discovery, and the adoption of solutions for making optimal health attainable for all. Details at ipsnow.org

BYLINE: Steven Infanti

The Appalachian region continues to experience disproportionately higher opioid overdose rates and related fatalities. According to the most recent Center for Disease Control and Prevention, fully one-half of the 16 states with the highest overdose death rates are Appalachian states. West Virginia tops the list, and is joined by, in descending order, Tennessee, Kentucky, Ohio, South Carolina, North Carolina, Pennsylvania, and Maryland. And although the CDC’s data shows a 4% overall overdose death rate decline, the statistics for Appalachia remain stubbornly high.

A Philadelphia-based non-profit foundation is combating the opioid addiction epidemic at the source by educating frontline allied health professionals on various aspects of the nation’s opioid crisis, specifically in Pennsylvania and the Appalachian region.

The Rothman Orthopaedic Institute Foundation for Opioid Research and Education (aka, Rothman Opioid Foundation) is a leader in opioid-related research and education. Thanks to a three-year grant from the federal Appalachian Regional Commission and support from the Pennsylvania General Assembly, the Foundation has used its expertise to educate allied health professionals in Pennsylvania and the broader Appalachian region on proper opioid prescribing and use.

Rothman Opioid Foundation has created and distributes opioid education curricula at no cost for the 75 allied healthcare professional training programs, such as nurse practitioners and physician assistants, at collegiate institutions across the Appalachian Region. In particular, the Foundation has produced an 8-module online pain management curriculum designed to complement any training program focusing on evidence-based pain management using opioid-sparing strategies.

“Physician assistants and nurse practitioners are valued professionals and are often on the front line of primary care and pain management, and they will greatly benefit from formal training in opioid pharmacology, use, abuse, and safe evidenced-based pain management strategies,” says Dr. Asif Ilyas, MD, MBA, FACS, President of the Rothman Opioid Foundation in Philadelphia, PA. The Foundation has developed its curriculum as a prescriber-training program and is offering this eight-hour course free of charge. It is an online, self-paced certificate program designed to effortlessly complement students’ current curriculum in the clinical phases of their training and prescribers in practice. The targeted allied health professionals include nurse practitioners (NPs) and physicians’ assistants (PAs). The curriculum’s training includes, but not be limited to, opioid prescribing guidelines and indications, pain management alternatives to opioids, identification of potential opioid abuse, and intervention strategies. Additional educational programs will include online webinar series and in-person events when feasible. The curriculum is designed to complement the clinical phase of NP and PA training programs but can be implemented at any stage in training. While designed specifically for NP and PA students, the Rothman Opioid Foundation submitted the course material to a rigorous national accreditation process. As a result, the curriculum has been accredited for up to 13.5 Continuing Medical Education (CME) credit hours. It satisfies the Federal Drug Enforcement Agency Medication Assisted Treatment Education (DEA MATE) Act 8-hour training requirement on the treatment and management of patients with opioid or other substance use disorders. That means any licensed prescriber, physician, NP, or PA can obtain the required CME or DEA MATE opioid training through this vital course material. While most opioid-related education currently targets physicians, Ilyas says, NPs and PAs often interact more with individuals who are suffering from or are susceptible to opioid misuse.

“NPs and PAs have prescribing rights. They are vital physician extenders who need to be educated and recruited in the fight against the opioid addiction crisis across the Appalachian region,” says Ilyas. “This information will be tailored specifically to these allied health professionals to mitigate the rate of opioid addiction at the source by teaching proper opioid use and early symptoms of misuse to decrease the risk of opioid dependency and abuse. “The Rothman Opioid Foundation plans to partner with colleges and universities to distribute this information to as many healthcare students as possible in the Appalachian Region. This project’s ultimate goals are to ensure that PAs and NPs have the proper resources and education to advise on proper opioid use and its alternatives, recognize the initial symptoms of opioid misuse and abuse, and understand when and how to intervene when substance abuse occurs.“The opioid addiction crisis has taken a drastic toll on the Appalachian region and the country. To lower the chance of misuse and overdose in patients, it is imperative that our local frontline healthcare workers are adequately trained and educated in the pathophysiology of opioid addiction, and they have resources available to guide effective and safe pain management,” says Ilyas.

According to the Centers for Disease Control and Prevention (CDC), 130 Americans die every day from opioid overdose. This includes prescription and illicit opioids. Low-income and rural areas are among the most likely to experience the opioid addiction crisis’s adverse effects, as evidenced by data published by the Appalachian Regional Commission. Rural residents are at greater risk in part due to a lack of resources or healthcare  services to address their addiction. These regions often lack accessible health services, especially those considered “specialized” services, such as addiction treatment.In addition, communities with a high uninsured population are at greater addiction risk as individuals without healthcare insurance are much less likely to receive treatment than those who are insured. These individuals are more likely to seek primary care through an urgent care setting, generally staffed by a physician extender (PAs and NPs).

As noted above, these allied health professionals have not always received the opioid-related education that their physician counterparts have.“Therefore, it is essential that professional education, designed to provide allied health professionals with the tools necessary to both manage pain in an evidenced-based opioid-sparing manner as well as screen for and identify addiction in the primary care setting visit, is available across Appalachia’s rural regions,” says Ilyas. Rothman Opioid Foundation is committed to providing the educational tools needed by our allied health professionals across the Appalachian region as they serve and treat on the front line of the opioid crisis. Information on the curriculum is found here: https://www.rothmanopioid.org/opioids-pain-management

About the Rothman Orthopaedic Institute Foundation for Opioid Research and Education.

The Rothman Orthopaedic Institute Foundation for Opioid Research & Education, www.rothmanopioid.org , is a non-profit 501c3 organization dedicated to raising awareness of the risks and benefits of opioids, educating physicians/physicians/policymakers on safe opioid use, and supporting research and education aimed to advance innovate pain management strategies that can decrease opioid use. The Foundation supports and advances the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidenced-based pain management strategies.

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Newswise — When seeking treatment for alcohol use disorder, how a person is functioning in society strongly influences how long they will stay in inpatient treatment. According to a study published in Alcohol: Clinical and Experimental Research, people who are dissatisfied in their primary social role—at work or school, for example—and people with a strong social network stay in treatment longer, giving them more opportunities for therapeutic intervention. The study highlights the importance of helping people in treatment for alcohol use disorder to strengthen their social network and social role.

The purpose of the study was to examine the modifiable factors affecting how long a patient stays in inpatient treatment for alcohol use disorder. Longer duration of stay is considered to be more beneficial to patients. Researchers collected data on 800 people being admitted to a short-term inpatient facility center in greater New York City between 2022 and 2024 to treat their alcohol and substance use disorders.

Sixty-five percent of participants used alcohol as their primary substance. The average length of stay in treatment ranged from two days to 43 days. A preliminary analysis found that total well-being, symptom distress, social role, total social network size, and alcohol use severity were significant predictors of length of stay; those factors were further analyzed. The preliminary analysis did not find an association between age, sex, race, ethnicity, or substance use disorder severity and length of stay.  

Further analysis found that social role, social network size, and severity of alcohol use disorder all significantly increased length of stay. Specifically, for each additional point on the social role measure, the length of stay increased by 0.12 days. This scale measures the individual’s satisfaction with what they consider to be their primary social role, whether in a work, school, volunteer, or other setting. The higher the number on this scale, which ranges from 9 to 45, the more dysfunctional the person’s social role. Individuals generally dissatisfied with their social role may be more inclined to stay in treatment to improve their function in those roles—or may be required to do so by their school or workplace.

Each of the three additional people listed in a patient’s social network was associated with an increased length of stay in treatment of one day. This result aligns with prior studies and may be because a larger social network means more support during treatment and more motivation to stay in treatment. The study also found that for every three additional alcohol use disorder symptoms a participant reported, their length of stay increased by one day.

The authors recommend further research at other treatment facilities and note that the study findings provide important insights for clinicians who can easily incorporate the social functioning measures used in the study into intake processes and communications among treatment teams, for example, through electronic health records. They recommend that treatment aims to improve the patient’s social functioning during treatment and after discharge, for instance, through vocational rehabilitation, and that clinicians leverage patients’ social networks to support their treatment and recovery. 

Correlates of length of stay in a short-term inpatient residential addiction treatment facility. J. Bourdon, S. Verdecanna, J. Wright, N. Vadhan, M.F. Wright, J. Morgenstern

ACER-24-6126.R2

Newswise — The prevalence of diagnosed disorders from recurrent use of sedative, hypnotic and antianxiety medications in adolescents and young adults has increased sharply since 2001, according to Rutgers Health researchers. 

Their study, published in Addiction, examined diagnoses of these disorders in adolescents and young adults between 2001 to 2019.

Sedative, hypnotic and antianxiety medications are used to treat a variety of conditions, including sleep and anxiety disorders. According to Harvard Health, consistent use of these drugs can lead to a higher tolerance for their effects, meaning patients require higher doses to achieve the intended effects.

For some, a problematic pattern of use of these medications can lead to significant impairment and distress. When this happens, patients may be diagnosed with sedative, hypnotic or anxiolytic use disorders, which are estimated to impact 2.2 million Americans, according to data from the National Survey on Drug Use and Health.

Using national Medicaid data from nearly 7 million adolescents and young adults in 2001 and 13 million adolescents and young adults in 2019, Rutgers Health researchers looked at trends in sedative, hypnotic or anxiolytic use disorder diagnoses. The prevalence increased threefold in adolescents and increased fivefold in young adults from 2001 to 2019.

“The increase in diagnoses of these disorders may be due to changes in the availability, use and misuse of sedatives, hypnotics and anxiolytics, as well as an increase in detection, awareness and diagnosing of these disorders,” said Greta Bushnell, an assistant professor at the Rutgers Center for Pharmacoepidemiology and Treatment Science (PETS) and lead author of the study.

Sedative, hypnotic and anti-anxiety medications are accessed in number of ways, including through medical prescriptions as well as through nonmedical sources such as a friend or in a medicine cabinet. Researchers found the prevalence of a sedative, hypnotic, or anxiolytic use disorders to be elevated in youths with prescriptions. However, the majority of adolescents and young adults diagnosed with a sedative, hypnotic or anxiolytic use disorder didn’t have a prescription for one of those medications.

“Efforts to target nonmedical use of these drugs is important as a means to reduce this disorder,” said Bushnell, who also is an assistant professor of epidemiology at Rutgers School of Public Health, “as is cautious prescribing in this young population.”

Researchers also found that most adolescents and young adults with sedative, hypnotic or anxiolytic use disorders had another comorbid substance use disorder diagnosis; in adolescents, cannabis use disorder was the most common and opioid use disorder in young adults. 

“While sedative, hypnotic and anxiolytic use disorders are less common than other substance use disorders, it warrants attention from clinicians and researchers given treatment difficulties and the association with other substance use issues,” Bushnell said.

Examining trends in youth diagnosed with this disorder can lead to a better understanding of the population and improve support through care and resources, say researchers.

Coauthors of the study include Kristen Lloyd and Tobias Gerhard of PETS and Rutgers Institute for Health, Health Care Policy and Aging Research; Katherine Keyes, Mark Olfson and Deborah Hasin of Columbia University; and Magdalena Cerdá of New York University.

A couple of years ago, Robert Wolfe was experimenting with an artificial intelligence system. He wanted it to complete the sentence, “The teenager ____ at school.” Wolfe, a University of Washington doctoral student in the Information School, had expected something mundane, something that most teenagers do regularly — perhaps “studied.” But the model plugged in “died.”

This shocking response led Wolfe and a UW team to study how AI systems portray teens. The researchers looked at two common, open-source AI systems trained in English and one trained in Nepali. They wanted to compare models trained on data from different cultures, and co-lead author Aayushi Dangol, a UW doctoral student in human centered design and engineering, grew up in Nepal and is a native Nepali speaker.

In the English-language systems, around 30% of the responses referenced societal problems such as violence, drug use and mental illness. The Nepali system produced fewer negative associations in responses, closer to 10% of all answers. Finally, the researchers held workshops with groups of teens from the U.S. and Nepal, and found that neither group felt that an AI system trained on media data containing stereotypes about teens would accurately represent teens in their cultures.

The team presented its research Oct. 22 at the AAAI/ACM Conference on AI, Ethics and Society in San Jose.

“We found that the way teens viewed themselves and the ways the systems often portrayed them were completely uncorrelated,” said co-lead author Wolfe. “For instance, the way teens continued the prompts we gave AI models were incredibly mundane. They talked about video games and being with their friends, whereas the models brought up things like committing crimes and bullying.”

The team studied OpenAI’s GPT-2, the last open-source version of the system that underlies ChatGPT; Meta’s LLaMA-2, another popular open-source system; and DistilGPT2 Nepali, a version of GPT-2 trained on Nepali text. Researchers prompted the systems to complete sentences such as “At the party, the teenager _____” and “The teenager worked because they wanted_____.”

The researchers also looked at static word embeddings — a method of representing a word as a series of numbers and calculating the likelihood of it occurring with certain other words in large text datasets — to find what terms were most associated with “teenager” and its synonyms. Out of 1,000 words from one model, 50% were negative.

The researchers concluded that the systems’ skewed portrayal of teenagers came in part from the abundance of negative media coverage about teens; in some cases, the models studied cited media as the source of their outputs. News stories are seen as “high-quality” training data, because they’re often factual, but they frequently focus on negative stories, not the quotidian parts of most teens’ lives.

“There’s a deep need for big changes in how these models are trained,” said senior author Alexis Hiniker, a UW associate professor in the Information School. “I would love to see some sort of community-driven training that comes from a lot of different people, so that teens’ perspectives and their everyday experiences are the initial source for training these systems, rather than the lurid topics that make news headlines.”

To compare the AI outputs to the lives of actual teens, researchers recruited 13 American and 18 Nepalese teens for workshops. They asked the participants to write words that came to mind about teenagers, to rate 20 words on how well they describe teens and to complete the prompts given to the AI models. The similarities between the AI systems’ responses and the teens’ were limited. The two groups of teens differed, however, in how they wanted to see fairer representations of teens in AI systems.

“Reliable AI needs to be culturally responsive,” Wolfe said. “Within our two groups, the U.S. teens were more concerned with diversity — they didn’t want to be presented as one unit. The Nepalese teens suggested that AI should try to present them more positively.”

The authors note that, because they were studying open-source systems, the models studied aren’t the most current versions — GPT-2 dates to 2019, while the LLAMA model is from 2023. Chatbots, such as ChatGPT, built on later versions of these systems typically undergo further training and have guardrails in place to protect against such overt bias.

“Some of the more recent models have fixed some of the explicit toxicity,” Wolfe said. “The danger, though, is that those upstream biases we found here can persist implicitly and affect the outputs as these systems become more integrated into peoples’ lives, as they get used in schools or as people ask what birthday present to get for their 14-year-old nephew. Those responses are influenced by how the model was initially trained, regardless of the safeguards we later install.”

Bill Howe, a UW associate professor in the Information School, is a co-author on this paper. This research was funded in part by the Connecting the EdTech Research EcoSystem research network.

For more information, contact Wolfe at [email protected] and Hinkier at [email protected].

EL PASO, Texas (Jan. 16, 2025) – Researchers at The University of Texas at El Paso have been awarded a $2.8 million grant from the National Institutes of Health (NIH) to explore the neurobiological mechanisms behind drug-taking behaviors and addiction.

The study will focus on striosomes, clusters of cells within the brain that play a pivotal role in decision-making, and will seek to address a critical issue: understanding how drugs of abuse impact decision-making processes and how these changes can drive costly and self-destructive behaviors.

“Striosomes appear to act as a gating mechanism for cortical signals related to dopamine, a neurotransmitter that is closely linked with reward-motivated behavior,” explained Alexander Friedman, Ph.D., the grant’s principal investigator and assistant professor in UTEP’s Department of Biological Sciences. “In individuals with substance use disorders, we believe this gating function is disrupted, which may explain why they continue pursuing drugs despite high costs.”

Substance use disorders remain a pressing public health crisis in the United States, with overdoses continuing to rank among the leading causes of death among adults, according to the Centers for Disease Control and Prevention (CDC). A hallmark of these disorders is the persistent pursuit of drugs, regardless of the often significant personal, financial, and social costs involved. While existing computational models have provided valuable insights into drug consumption and craving, they have largely ignored the role of cost in decision-making — an omission this project aims to rectify, said Friedman.

The study combines experimental work using animal models with the development of an advanced computational neurobiological model. Such models allow researchers to simulate and test hypotheses about how neurological processes influence behavior, offering tools to better understand the intricate relationship between drug use, decision-making, and neural activity.

Travis Moschak, Ph.D., assistant professor and co-principal investigator, highlighted the interdisciplinary nature of the project: “This study is a synthesis of behavioral neuroscience and computational biology. We’re not only exploring how drugs affect brain activity but also how this activity translates into real-world behaviors. It’s a critical step toward bridging basic science and practical applications.”

The project will involve extensive collaboration and student engagement. Friedman leads one of the largest research teams at UTEP, including 10 graduate students. Moschak’s lab will contribute an additional three graduate students, all of whom will be funded through the NIH grant.

“This grant represents an incredible opportunity for our students to contribute to groundbreaking research while gaining hands-on experience in the lab,” said Friedman. “Many of them are already deeply involved in the experimental and computational aspects of this study, and their contributions are invaluable.”

The study is part of a larger effort at UTEP to advance foundational research that can lead to real-world applications. Friedman emphasized the importance of this sort of translational research, which focuses on turning scientific discoveries into practical treatments such as medications or therapies to address addiction and prevent relapse in individuals.

“With additional financial support for translational research, the time it takes to develop new treatments could be significantly reduced — from decades to much less,” Friedman noted. “This kind of funding — which often comes from private entities — is crucial for ensuring that our findings have a direct impact on people’s lives.”

“We are incredibly proud of Dr. Friedman, Dr. Moschak, and their teams for securing this prestigious grant,” said Robert A. Kirken, Ph.D., dean of UTEP’s College of Science. “Their work exemplifies the impactful research happening at UTEP, and it aligns perfectly with our mission of serving the community. This study has the potential to transform lives, and we are deeply grateful for their efforts.”

About The University of Texas at El Paso

The University of Texas at El Paso is America’s leading Hispanic-serving university. Located at the westernmost tip of Texas, where three states and two countries converge along the Rio Grande, 84% of our 25,000 students are Hispanic, and more than half are the first in their families to go to college. UTEP offers 171 bachelor’s, master’s and doctoral degree programs at the only open-access, top-tier research university in America.