The world’s total population is expected to reach 9.9 billion by 2050. This rapid increase in population is boosting the demand for agriculture to cater for the increased demand. Below are some of the latest research and features on agriculture and farming in the Agriculture channel on Newswise.
Newswise — PHILADELPHIA— Patients who are younger or who haven’t taken opioid pain medication before are more likely to not need any after many common surgeries, according to new research from the Perelman School of Medicine. Additionally, the study, published in Annals of Surgery Open, showed that simply understanding a patient’s history with opioids and how they are feeling upon leaving the hospital could help clinicians tailor the amount of prescription pain medicines they may need as they transition home.
“At face value, it seems quite simple that asking patients about their pain and use of pain medicine would help inform what we do, but it is often easy to lose sight of the value of these patient-informed moments,” said first author Anish Agarwal, MD, an assistant professor of Emergency Medicine and the deputy director of the Penn Medicine Center for Insights to Outcomes. “These are simple data points, but they could be used in a high impact way to help manage pain, tailor prescribing, and support clinicians who are trying to better balance the risks of opioids while addressing expected pain following surgery.”
The study, co-led by Kit Delgado, MD, an associate professor of emergency medicine and epidemiology and the director of the Penn Medicine Nudge Unit and co-chair of the Penn Medicine Opioid Task Force, used data collected through automated text messages sent to approximately 3,600 patients who had one of the 30 most common surgical procedures at the University of Pennsylvania Health System. Mostly, these surgeries fell under the umbrella of orthopaedic (such as hip or knee procedures) or neurosurgery (spine or back procedures).
Among the questions surgery patients were asked via text message were whether they filled their opioid prescription, their pain level on a scale of one to ten, how well they felt they could manage the pain, and how many opioid tablets they actually used.
“Previously, our team had used this automated text messaging program to generate procedure-specific guidelines, and these guidelines recommended a default quantity that would cover most patient needs, though most would need less and some needed more,” Delgado said. “We wanted to use the data to identify some common factors that could guide clinicians to “right size” prescriptions based on a patient’s personal characteristics.”
Overall, of patients who hadn’t taken opioids before (termed opioid naivety), more than half used either none or less than five of the opioid tablets they’d been prescribed. The researchers found that in hip replacements, patients who were opioid naïve and rated their pain low when being discharged used an average of about five opioid tablets while patients who had used opioids before and rated their pain high at discharge used an average of 20 tablets.
And in procedures where the hospitals’ guideline was to prescribe 15 opioid tablets or fewer, patients who were in the lowest age bracket (18-34 years old) and who hadn’t taken opioids before were significantly likely to not take any of the pain medication they were prescribed or, if they did, take just five tablets or fewer. The same held true in procedures where 20 opioid tablets were recommended.
Could it be possible that the opioid epidemic and new attention around it is affecting the way younger patients — who came of age during this time period — use pain medication?
“We know that clinicians are trying to prescribe fewer opioids and, anecdotally, we hear that patients have more concerns about opioid use,” said Agarwal. “Nonetheless, there are instances where opioids, when taken in limited quantities and for short periods, are effective tools to help patients manage severe pain – for instance after a major surgery. We’re hoping this work can alleviate some concerns, as well as some of the issues surrounding leftover medications.”
Because the researchers found a correlation between use of opioids and the severity of pain that patients reported upon discharge, the researchers believe that simple measures can be used in the moment by clinicians to help adjust prescriptions to specific patient needs. For example, if a patient reports their pain as a “3,” giving them the same amount of opioids than a patient rating their pain an “8” may not be necessary. And, by extension, that could help cut down on the leftover opioids after surgeries that can be misused and circulated.
For example, in hip replacements, again, the opioid naïve, low-pain patients only needed about five tablets of opioids. But opioid naïve patients who underwent the same procedure and rated their pain as high needed almost 15 tablets, on average.
This research extends other work by Agarwal, Delgado, and their colleagues seeking to cut down on the possibilities of having leftover opioids after surgeries. That includes mailing order disposal kits and using a texting program similar to the one in this study to monitor how many opioids patients used, in real-time.
“The next steps here are to take this research and translate it into actual clinical practice,” Agarwal said. “We’ve already used the feedback from our patients to help support our existing guidelines, and with this data our clinicians can become even more specific to personalize the approach to pain management for patients. We are beginning to see opportunities to help create new pathways for clinical decision support across large systems and for thousands of patients, but in a way that is still personalized based on their history and pain trajectory.”
This study was funded through the Food and Drug Administration (HHSF223201810209C).
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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.
The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is an $11.1 billion enterprise powered by more than 49,000 talented faculty and staff.
By: Bill Wellock | Published: November 14, 2023 | 2:43 pm | SHARE: The U.S. Food and Drug Administration recently approved the medication Zepbound for weight management treatment.Tirzepatide, the active ingredient in the Eli Lilly and Company’s trademarked Zepbound, was already approved to help improve blood sugar (glucose) in adults with type 2 diabetes mellitus.
IU School of Medicine researchers are taking steps to improve the accessibility and quality of care for adolescents experiencing opioid use disorder (OUD) and other substance use disorders (SUDs), thanks to a new $5 million grant from the National Institute of Health’s Helping to End Addiction Long-Term (HEAL) Initiative.
Newswise — In 2021, 61.2 million Americans ages 12 and older used illicit drugs and more than 106,000 died from drug-involved overuse. Florida ranks second to California, with 5,300 annual overdose deaths, outpacing the national average by about 23 percent. Excessive alcohol use is the leading cause of preventable death in the United States and is associated with numerous health issues, including heart disease, cancer and poor mental health.
Although individuals with substance use disorder use outpatient sober support services and resources, relapse rates are still as high as 70 percent, indicating a need for more treatment modalities.
A new Florida Atlantic University pilot study is showing promise in treating addiction cravings by combining eye movements and guided instructions to process memories. The evidence-based therapy – Eye Movement Desensitization Reprocessing (EMDR) – has proven to be effective in treating PTSD, depression, anxiety and other mental health conditions. However, research exploring this method for substance use disorder is sparse.
Since cravings are maintained and heightened by sensory imagery stored in memories, with more vivid imagery predicting higher craving intensity, one of the goals of the FAU study was to transform dysfunctional memories stored in the brain through processing and integration. Addiction memory, assumed to be episodic, resembles the maladaptive traumatic memory formation commonly seen in post-traumatic stress disorder.
“Because Eye Movement Desensitization Reprocessing has been shown to reduce the vividness of negative memories associated with trauma, we anticipated that this therapy would also reduce the vivid imagery that fuels addiction cravings,” said Elizabeth Woodruff, first author, a graduate of the Phyllis and Harvey Sandler School of Social Work within FAU’s College of Social Work and Criminal Justice, and a practicing clinical therapist in West Palm Beach. “This method accesses trauma events in very specific ways to reprocess what the individual remembers from the negative event to ‘repair’ the mental injury from that memory.”
FAU’s “Addiction-focused Eye Movement Desensitization Reprocessing” study focused on cravings, perseverative thoughts (repetitive negative thinking), and irrational cognitions about the substance of choice. For the study, researchers tested Addiction-focused EMDR with and without cognitive behavioral therapy, a psycho-social intervention aimed to reduce symptoms of various mental health conditions including depression and anxiety disorders.
Results of the study, published in the Journal of Evidence-based Social Work, showed a significantly high participant retention rate (nearly 100 percent). Addiction-focused EMDR was as effective as cognitive behavioral therapy for cravings with the combination of both resulting in more reduction in craving than cognitive behavioral therapy alone. Both groups (experimental group and control group using only cognitive behavioral therapy) had clinically significant reductions in cravings, perseverative thoughts, and irrational cognitions, with the experimental group showing greater decreases overall.
“While the purpose of our pilot study was to test Addiction-focused Eye Movement Desensitization Reprocessing on chemical addiction cravings, our findings indicate that it also can be highly effective with issues that are not chemical but rather compulsory in nature, such as Internet addiction and gambling. However, more randomized control trials are necessary to confirm our findings and develop a transparent understanding of the number of sessions needed to cultivate statically significant outcomes that are replicable for future studies,” said JuYoung Park, Ph.D., second author and a professor in FAU’s Phyllis and Harvey Sandler School of Social Work. “Importantly, this therapy is a valuable add-on to current addiction treatment to address memories that drive addiction cravings, which also impacts maladaptive thought patterns associated with relapse.”
EMDR is an eight-phase intervention: in-depth client history, preparation, assessment, desensitization, installment, body scan, closure and reevaluation.
Participants in the experimental group received 60 minutes of individual cognitive behavioral therapy once a week, followed by Addiction-focused EMDR. Researchers explored past memories of relapse (first, worst, most recent) and cravings (first, worst, most recent) and current triggers. They identified future fears, which were desensitized with Addiction-focused EMDR.
Nearly 57 percent of the study participants reported alcohol as their primary substance dependence and 20 percent reported heroin or other opiates, including morphine, as their primary substance dependence.
Currently, individuals with substance use disorder are encouraged to attend inpatient treatment that employs group therapy to educate patients on addiction, coping skills, and thought-stopping techniques, and cognitive behavioral therapy, along with pharmacological options such as anti-craving drugs.
As perseverative thoughts were found to be an important predictor of relapse, the researchers say findings from their study show that pairing Addiction-focused EMDR with cognitive behavioral therapy, could decrease relapse rates and help people with substance use disorder to maintain long-term recovery in inpatient or even outpatient treatment centers.
Study co-authors are Heather Howard, Ph.D., associate professor; Manny Gonzalez, Ph.D., associate professor; both in FAU’s Phyllis and Harvey Sandler School of Social Work; and Talib Jaber, RPh, vice president of customer success, Sunwave.
– FAU –
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 — Medical cannabis legalization is associated with a decrease in the frequency of nonmedical prescription opioid use, according to a Rutgers study.
The study, published in the International Journal of Mental Health and Addiction, examined data from a nationally representative survey of adults who reported nonmedical prescription opioid use – or using prescription medications without a prescription or in a manner other than prescribed.
According to the study, when states implement medical cannabis laws, there is a 0.5 to 1.5 percentage point decrease in regular to frequent (up to or greater than once per week on average) nonmedical prescription opioid use among people who reported using opioids in the previous year. However, these reductions were concentrated in people who met diagnostic criteria for cannabis addiction.
Still, the pros of legalizing marijuana to address risky opioid use should be considered alongside the cons, according to Hillary Samples, faculty member at the Center for Pharmacoepidemiology and Treatment Science in the Rutgers Institute for Health, Health Care Policy and Aging Research and lead author of the study.
“There might be some benefits to allowing legal access to medical cannabis in the context of opioid-related harms,” Samples said. “However, from a policy perspective, there are much more effective interventions to address the ongoing overdose crisis, such as increasing access to treatment for opioid addiction.”
According to the Centers for Disease Control and Prevention, the rate of drug overdose deaths rose more than 14 percent from 2020 to 2021 in the United States. To understand approaches to mitigate this crisis, researchers have examined whether cannabis serves as an alternative to opioid use as cannabis might help with pain and symptoms of opioid withdrawal.
With existing research showing mixed findings on the relationship between medical cannabis legalization and opioid use, a team of researchers led by Samples sought to contribute to this evidence.
Samples, an assistant professor of health systems and policy at the Rutgers School of Public Health, said the results suggest people may be replacing opioids with cannabis, but because the decrease in opioid use is modest and limited to high-risk cannabis users, study researchers call for investment in opioid addiction treatment.
The researchers said future studies should seek to understand whether the reductions in the frequency of nonmedical opioid use are meaningful in relation to the widespread opioid addiction crisis as well as whether the reductions in opioid use coincide with increases in cannabis use disorder.
“Policymakers should weigh the overall evidence on the effectiveness of various approaches to reduce opioid-related problems and consider potential trade-offs,” Samples said.
Coauthors of the study include Natalie Levy, Emilie Bruzelius, Luis Segura, Pia Mauro, Christine Mauro and Silvia Martins of the Columbia University Mailman School of Public Health and Anne Boustead of the University of Arizona.
New research finds that almost half of people who use illicit drugs in rural areas have been recently incarcerated.
As you plan health coverage over the next few weeks, Ochsner Health has medical experts on standby to cover a variety of topics.
Newswise — November 8, 2023 — Among cancer patients, psychological distress and accessibility of opioids often lead to chemical coping, a middle ground between addiction and proper adherence to a medication regimen. Chemical coping can diminish quality of life and interfere with pain and symptom management, as well as predispose individuals to developing substance use disorder. The findings are reported in the Harvard Review of Psychiatry (HRP), part of the Lippincott portfolio from Wolters Kluwer.
Miryam Yusufov, PhD, a psychologist in the Department of Psychosocial Oncology and Palliative Care at the Dana-Farber Cancer Institute, a Harvard Medical School teaching hospital in Boston, and colleagues have developed the first conceptual model that integrates the risk factors that initiate and maintain chemical coping with opioids during cancer care. “This model will help care teams triage factors that require monitoring and potential risk mitigation . . . as well as those that require behavioral intervention,” the research team notes.
Predisposing risk factors identified in four overlapping domains
Based on a search of medical literature in PubMed and MEDLINE, the team found that risk factors and treatment targets for chemical coping in cancer can be organized according to whether they are historical or current and whether they are malleable (amenable to intervention) or unmalleable. The researchers describe the evidence base for each risk factor, some of which fall into multiple domains:
“Therefore, patients with no misuse behaviors are still at risk for chemical coping based on these preexisting risk factors and long-term opioid therapy,” the authors say.
Implications for clinical practice: universal screening, patient education, and mental health care
Dr. Yusufov and her colleagues recommend screening all patients for risk of chemical coping before initiating opioid therapy. They point out that “it is less stigmatizing to address chemical coping risk than active misuse of opioids.” For example, the Opioid Risk Tool (ORT) addresses family and/or personal history of substance use, history of sexual abuse/violence, and psychological disorders.
Given the recent upward trend in opioid-related hospitalizations among patients with cancer, the authors suggest clinicians may mitigate overdoses and deaths with patient education on naloxone and medication return policies upon therapy completion or regimen changes.
Finally, the proposed model can aid in selecting components for behavioral interventions and help clinicians determine when to refer patients to psychosocial support resources. This approach can maximize cost-effectiveness while minimizing risk. “For example, if a patient presents with predominantly malleable factors, they may be an appropriate candidate for psychosocial support,” Dr. Yusufov’s team says. “If a patient presents with predominantly unmalleable factors, however, they may be a more appropriate candidate for continued monitoring throughout opioid therapy.”
Read Article [ Toward a Psychological Model of Chemical Coping with Opioids in Cancer Care ]
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About HRP
Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer-reviewed and not industry-sponsored. It is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals.
Articles encompass all major issues in contemporary psychiatry, including (but not limited to) neuroscience, psychopharmacology, psychotherapy, history of psychiatry, and ethics. In addition to scholarly reviews, perspectives articles, and columns, the journal includes a Clinical Challenge section that presents a case followed by discussion and debate from a panel of experts.
About Wolters Kluwer
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Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,900 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.
Newswise — Online shopping for cigarettes and vaping products increased significantly in the weeks following the implementation of SB-793, a 2022 California law prohibiting the sale of flavored tobacco products. Researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego identified potential loopholes in tobacco control policies due to the absence of explicit regulations on e-commerce sales in retailer licensing programs.
Reporting in the journal Tobacco Control on Nov. 7, 2023, researchers assessed the impact of California’s statewide flavor restriction on online shopping behavior among consumers. Comparing observed rates of shopping queries with expected rates, researchers discovered that shopping queries were 194 percent higher than expected for cigarettes and 162 percent higher than expected for vape products.
“Retailer licensing programs have proven to be effective in enforcing tobacco control laws. However, the exclusion of e-commerce retailers from these programs can undermine their impact,” said principal investigator Eric Leas, PhD, MPH, an assistant professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego and director of the Tobacco E-commerce Lab.
Despite the flavor restriction imposed by SB-793, analysis of the first 60 websites returned in the search queries presented at least two online retailers offered access to flavored vaping products or menthol cigarettes to consumers in California — with one query returning as many as 36 websites (60 percent of the search results) — highlighting the potential shortcomings of retailer licensing programs that do not include e-commerce retailers in their regulations.
“The absence of explicit regulations on e-commerce sales can create loopholes in enforcing tobacco control laws, allowing consumers to easily access restricted products online,” said Leas. “By including e-commerce in the definition of ‘tobacco retailer’ and ensuring strict compliance monitoring, we can close these loopholes and improve the effectiveness of tobacco control policies.”
To address these concerns, the study authors recommend strengthening regulations to include e-commerce retailers within the scope of retailer licensing programs. Additionally, they emphasized the importance of monitoring online compliance to ensure the effectiveness of laws enforced through retailer licensing programs.
“The study’s findings have important implications for policymakers and public health advocates, emphasizing the need for comprehensive regulations that address the challenges posed by the growing e-commerce market for tobacco products,” said Leas.
Co-authors include: Tomas Mejorado, Raquel M. Harati, Shannon E. Ellis, Nora Satybaldiyeva, and Nicolas E. Morales, all of UC San Diego; and Adam Poliak, Byrn Mawr College.
This research was funded, in part, by the Tobacco Related Disease Research Program (T32IP4684).
Disclosures: The authors do not have any conflicts of interest to report.
Title: The E-Commerce Licensing Loophole: A Case Study of Online Shopping for Tobacco Products Following a Statewide Sales Restriction on Flavored Tobacco in California
DOI: http://dx.doi.org/10.1136/tc-2023-058269
