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Opioid limits didn't change surgery patients' experience, study shows

Original post: Newswise - Substance Abuse Opioid limits didn't change surgery patients' experience, study shows

Newswise — Worries that surgery patients would have a tougher recovery if their doctors had to abide by a five-day limit on opioid pain medication prescriptions didn’t play out as expected, a new study finds.

Instead, patient-reported pain levels and satisfaction didn’t change at all for Michigan adults who had their appendix or gallbladder removed, a hernia repaired, a hysterectomy or other common operations after the state’s largest insurer put the limit in place, the study shows.

At the same time, the amount of opioid pain medication patients covered by that insurer received dropped immediately after the limit went into effect. On average, patients having these operations received about three fewer opioid-containing pills.

The study, which merges two statewide databases on patients covered by Blue Cross Blue Shield of Michigan (BCBSM), is the first large study to evaluate whether opioid prescribing limits change patient experience after surgery.

It’s published in JAMA Health Forum by a team from Michigan Medicine, the University of Michigan’s academic medical center.

Measuring the impact of limits from patients’ perspectives

The BCBSM limit of five days’ supply, which went into effect in early 2018, is even stricter than the seven-days’ supply limit put in place a few months later by the state of Michigan. Other major insurers and states have also implemented limits, most of which allow are seven-day limits.

Limits are designed to reduce the risk of long-term opioid use and opioid use disorder, as well as to reduce the risk of accidental overdose and the risk of unauthorized use of leftover pills.

“Opioid prescribing limits are now everywhere, so understanding their effects is crucial,” said Kao-Ping Chua, M.D., Ph.D., the study’s lead author. “We know these limits can reduce opioid prescribing, but it hasn’t been clear until now whether they can do so without worsening patient experience.”

He noted that even the 15% of patients who had been taking opioids for other reasons before having their operations didn’t show an increase in pain or a decrease in satisfaction after the limit was put in place, even though opioid prescribing for these patients decreased. That decrease was actually contrary to the intent of the limit, which was only designed to reduce prescribing to patients who hadn’t taken opioids recently.

Chua and several of his co-authors belong to the U-M Opioid Research Institute and Institute for Healthcare Policy and Innovation. In addition to his work on opioids, Chua is an assistant professor of pediatrics at the U-M Medical School and a member of the Susan B. Meister Child Health Evaluation and Research Center at U-M.

Some of the authors helped develop evidence-based surgical opioid prescribing guidelines published by U-M’s Opioid Prescribing Engagement Network (OPEN), a group that recommends prioritizing non-opioid pain relief and limiting prescriptions to no more than 10 opioid pills for most of the operations considered in the study.

How the study was done

For the new study, Chua and colleagues used data from the Michigan Surgical Quality Collaborative, which collects data on patients having common operations at 70 Michigan hospitals.

Funded by BCBSM as a collaborative quality initiative under its Value Partnerships effort, MSQC surveys patients about their pain, level of satisfaction and level of regret after their operations.

The team paired anonymized MSQC data with data on controlled substance prescription fills from the state’s prescription drug monitoring program, called MAPS.

In all, they were able to look at opioid prescribing and patient experience data from 1,323 BCBSM patients who had common operations in the 13 months before the five-day limit went into effect, and 4,722 patients who had operations in the 20 months after the limit went into effect.

About 86% of both groups were non-Hispanic white, patients’ average age was just under 49,  and just under a quarter of both groups had their operations on an emergency or urgent basis. Just under half were admitted to the hospital for at least one night.

About 27% of both groups had their gallbladders taken out laparoscopically, and a similar percentage had minor hernia repairs. About 10% had an appendectomy done laparoscopically, and a similar percentage had laparoscopic hysterectomies. The rest had more invasive procedures, like open hysterectomies major hernia repairs, or colon removal. 

The percentage of prescribers who prescribed opioids to their patients having these operations did not change, but the percentage of patients who filled a prescription for an opioid did, possibly because pharmacists rejected prescriptions that weren’t compliant with the BCBSM limit, Chua speculates.

Jennifer Waljee, M.D., M.P.H., M.S., senior author of the study, notes that the MSQC database doesn’t include all types of procedures, such as knee replacements and spine surgery, which typically require larger postoperative opioid prescriptions because of their associated pain.

She indicated that it’s important to understand the impact of opioid prescribing limits on the experiences of such patients, because limits have the most potential to worsen pain for these individuals. 

“Opioid prescribing limits may not worsen patient experience for common, less-invasive procedures like those we studied, because opioid prescriptions for most of these procedures were already under the maximum allowed by limits. But this may not be the case for painful operations where opioid prescribing was suddenly cut from an 8- to 10-day supply to a 5-day supply,” said Waljee, an associate professor of surgery at the Medical School and director of the U-M Center for Healthcare Outcomes & Policy.

She added, “The message of this study is not that we can simply go to five days’ supply across the board for operations. We need to understand the effects of these limits across a broad range of procedures and patients given how much pain needs vary in order to right size prescribing to patient need without resulting in additional harms.”

In addition to Chua and Waljee, the study’s authors are Thuy Nguyen, Ph.D. of the U-M School of Public Health, Chad Brummett, M.D., Amy Bohnert, Ph.D., Vidhya Gunaseelen, M.B.A., M.S., M.H.A., and Michael Englesbe, M.D. of the Medical School.

The study was supported by BCBSM Value Partnership infrastructure funding and the National Institute on Drug Abuse (DA057284, DA056438, DA048110).

Reference: Changes in Surgical Opioid Prescribing and Patient-Reported Outcomes After Implementation of an Insurer Opioid Prescribing Limit, JAMA Health Forum, https://jama.jamanetwork.com/article.aspx?doi=10.1001/jamahealthforum.2023.3541

International team of scientists says identifying some foods as addictive could stimulate research, shift attitudes

Newswise — Researchers from the United States, Brazil, and Spain, including scientists with the Fralin Biomedical Research Institute at VTC, published an analysis in a special edition of the British Medical Journal with a timely and controversial recommendation: It’s time for an international shift in the way we think about ultra-processed food.

“There is converging and consistent support for the validity and clinical relevance of food addiction,” said Ashley Gearhardt, the article’s corresponding author and a psychology professor at the University of Michigan. “By acknowledging that certain types of processed foods have the properties of addictive substances, we may be able to help improve global health.”

While people can give up smoking, drinking, or gambling, they can’t stop eating, said co-author Alexandra DiFeliceantonio, assistant professor at the Fralin Biomedical Research Institute. The challenge, and the still open and controversial question, is defining which foods have the most potential for addiction and why.

Their work was published Oct. 10 in Food For Thought, a special edition of the British Medical Journal, a high-impact publication and one of the world’s oldest medical journals.

DiFeliceantonio is also associate director of the Fralin Biomedical Research Institute’s Center for Health Behaviors Research and an assistant professor in the Department of Human Nutrition, Foods, and Exercise in the College of Agriculture and Life Sciences at Virginia Tech.

Not all foods have the potential for addiction, the researchers said. 

“Most foods that we think of as natural, or minimally processed, provide energy in the form of carbohydrate or fat — but not both,” DiFeliceantonio said.

Researchers gave the example of an apple, salmon, and a chocolate bar. The apple has a carbohydrate to fat ratio of roughly 1-to-0, while the salmon has a ratio of 0-to-1. In contrast, the chocolate bar has a carbohydrate to fat ratio of 1-to-1, which appears to increase a food’s addictive potential.

“Many ultra-processed foods have higher levels of both. That combination has a different effect on the brain,” DiFeliceantonio said. Researchers also called for more study into the role of food additives used in industrial processing. Key takeaways from the analysis include:

  • Behaviors around ultra-processed food, which are high in refined carbohydrates and added fats, may meet the criteria for diagnosis of substance use disorder in some people. Those behaviors include less control over intake, intense cravings, symptoms of withdrawal, and continued use despite such consequences as obesity, binge eating disorder, poorer physical and mental health, and lower quality of life.
  • This global health challenge needs to consider geographic differences. In a review of 281 studies from 36 different countries, researchers found ultra-processed food addiction is estimated to occur in 14 percent of adults and 12 percent of children. In some countries, ultra-processed foods are a needed source of calories. Even within high-income countries, food deserts and other factors could limit access to minimally processed foods. People facing food insecurity are more reliant on ultra-processed foods, and therefore more likely to demonstrate food addiction, researchers noted.
  • Viewing some foods as addictive could lead to novel approaches in the realm of social justice, clinical care, and public policy. Policies implemented in Chile and Mexico — taxes, labelling, and marketing — are associated with decreases in caloric intake and purchases of foods high in sugar, saturated fat, and salt, for example. And in the United Kingdom, a salt-reduction program was associated with a decline in deaths from stroke and coronary artery disease.

The co-authors represent international expertise on food addiction, nutrition physiology, gut-brain reward signaling, food policy, behavioral addiction, and eating disorders. They call for more study and science surrounding ultra-processed foods,

“Given how prevalent these foods are — they make up 58 percent of calories consumed in the United States — there is so much we don’t know.” DiFeliceantonio said. 

The researchers call for more study into such areas as: how complex features of ultra-processed foods combine to increase their addictive potential; better defining which foods can be considered addictive; differences among countries and communities, including disadvantaged communities; the value of public-health messaging; and clinical guidelines for preventing, treating, and managing addiction to ultra-processed foods.

In addition to Gearhardt and DiFeliceantonio, authors include Nassib B. Bueno, a professor at Universidade Federal de Alagoas in Brazil; Christina A. Roberto, associate professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine; and Susana Jiménez-Murcia and Fernando Fernandez-Aranda, both professors in the Department of Clinical Psychology at the University Hospital of Bellvitge in Spain.

DiFeliceantonio is not the only Virginia Tech researcher whose work appears in the special edition. Valisa Hedrick, an associate professor with the Department of Human Nutrition, Foods, and Exercise, is also featured. Hedrick’s work highlights nutritional uncertainty and the need for more research into non-sugar sweeteners.

Five years of legal cannabis in Canada: mixed success

Newswise — Five years after cannabis legalization in Canada, it appears to be a mixed success, with social justice benefits outweighing health benefits, write authors in a commentary published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230808.

Cannabis use was legalized in Canada in October 2018, with the goal to improve cannabis-related public health and safety, and reduce youth access and illegal activities related to cannabis. There was concern among some health professionals that legalization could lead to adverse health effects in Canadians.

“Limited evidence exists to support benefits as they relate to the original stated policy objectives of improving cannabis users’ and public health,” writes Dr. Benedikt Fischer, Simon Fraser University, Vancouver, BC, with coauthors. “At this stage, cannabis legalization in Canada appears not to have been the public health disaster anticipated by some of its opponents, but it cannot be described as a comprehensive or unequivocal success for public health either.”

Evidence indicates that cannabis use, cannabis-related emergency department visits and admissions, and cannabis-related impaired driving have stayed the same or increased. On the other hand, most cannabis consumers now obtain their cannabis from legal, rather than illegal, sources, and cannabis-related arrests, along with personal burdens from stigma and possible criminal records among adults and youth have decreased substantially. The authors assert these are important social justice benefits that may have indirect positive health effects.

“These major societal benefits of legalization must be included in any systematic assessments of the policy reform’s impacts,” write the authors.

Ongoing monitoring of cannabis use in adults, youth and high-risk people, and major health harms such as cannabis use disorder, cannabis-related injuries, hospital admissions or emergency department visits, and related crime and other socioeconomic indicators is needed to better understand the impact of legalization.

Bristol unites international gambling harms experts and people suffering from gambling addiction to highlight urgent need for reform

Newswise — With the explosion of online platforms and advertising, the scourge of gambling is a growing problem affecting people of all ages. This week world-leading researchers, campaigners, support bodies, and people with lived experience are set to gather in Bristol to raise awareness of the pressing issues and call for urgent national policy change, as the UK Government continues to consider reforming the Gambling Act.

The Bristol Hub for Gambling Harms Research will host its first-ever annual International Interdisciplinary Colloquium on Thursday 12 October at the M Shed in Bristol.

Former England football player Peter Shilton OBE, who was hooked on gambling for 45 years, will be speaking at the event with his wife Steph, a qualified therapist who helped him overcome the costly addiction. 

Steph said: “Without studies and research none of us can claim to be experts in our subjects as we have no basis. The research is imperative for those foundations in building our knowledge.” 

Peter added: “We are really looking forward to attending and speaking at this event. Steph and myself are proud to be patrons of the grassroot football study and to support the terrific work being undertaken by the University of Bristol for research into gambling harms.”

Other speakers include Lord Foster of Bath, who was an MP for more than 20 years and now chairs Peers for Gambling Reform, the largest cross-party group in the House of Lords and investigative journalist and author Rob Davies, acclaimed for exposing the insidious business practices within the UK’s gambling industry.

Lord Foster of Bath said: “I have met too many people who have experienced gambling harm and families of loved ones who have committed suicide because of it. It’s clear large numbers of people are affected daily, including children.

“The Government’s White Paper includes some important measures to address this issue, including recognition at last that this is a serious public health issue. But there are also many shortcomings. I’m extremely disappointed so very little is being done to limit the way we’re all bombarded with gambling advertising and direct marketing.

“The promotion of gambling products has grown exponentially, with an annual spend of £1.5billion, along with providers using ever more sophisticated means to attract new customers, persuade existing ones to spend more, and keep them hooked. This activity needs much greater scrutiny and regulation.”

More than 150 gambling harms experts covering health, policy, regulations, and marketing, from countries including Germany, Belgium, Ireland and Singapore are attending to explore and progress how to build capacity in gambling harms research. Delegates will consider factors drawing people into harmful gambling, how this deepens socio-economic inequalities and what innovative interventions can help combat these trends.

Professor Agnes Nairn, Co-Director of the Bristol Hub for Gambling Harms Research and Pro Vice-Chancellor for Global Engagement at the University of Bristol, said: “Experience of gambling harms is a worldwide phenomenon. However, the cultural context, provision of support and approach to regulation varies dramatically across countries. We are delighted to bring together experts from 13 nations to debate how strong interdisciplinary research can help tackle this growing issue.”

Counsellors from charity Ara (Addiction Recovery for All), which have a base in Bristol, and similar organisations will also be joining the event to raise awareness of the help available, treatment providers, as well as offering peer support. A representative from the Youth Advisory Board of GamCare will share insights on how gambling affects young people and what they want to change.

Last month University of Bristol-led research revealed the extent gambling messages saturate UK media coverage and social media during the opening weekend of the English Premier League football season. The investigation found that football fans are bombarded with 11,000 gambling messages during a single weekend, with only a fifth (20.6%) of these messages found to include gambling harm reduction messages and even fewer (18.7%) that featured age warnings.

Co-lead researcher Dr Raffaello Rossi, Lecturer in Marketing at the University of Bristol, who is also part of the event, said: “Self-regulation of the gambling industry is completely failing.  The gambling industry’s primary goal is profit, not public welfare. So, of course they will not implement measures that actually reduce gambling and their profits. This is why the UK Government have to step up and start protecting people from predatory and excessive gambling marketing.

“Other countries such as Italy, Spain, Poland, Netherlands and Belgium have all started to introduce harsh restrictions and even bans on gambling marketing.  It is shocking that the White Paper has completely ignored the need for stricter gambling marketing curbs – something strongly supported by the public.”

Last year the University of Bristol launched the Bristol Hub for Gambling Harms Research to lead pioneering multidisciplinary research into the wide-reaching effects of gambling harms.

The independent hub, funded by a grant of £4million from GambleAware, facilitates world-leading research to improve understanding of gambling harm as a growing public health issue which needs greater scrutiny and regulation.

Researchers describe horrific effects of new drug threat, xylazine, or “tranq”

Original post: Newswise - Substance Abuse Researchers describe horrific effects of new drug threat, xylazine, or "tranq"

Xylazine, an animal sedative that is approved by the U.S. Food and Drug Administration (FDA) for veterinary use only, has made its way into the illicitly manufactured fentanyl (IMF) supply and has significantly increased in prevalence in recent years, likely due to its low cost, easy availability, and presumed enhanced “high.” Researchers reviewed pertinent xylazine research and pulled from their own clinical experience to offer new guidance on the care of patients exposed to this dangerous drug. Their review is published in Annals of Internal Medicine.

Prescription opioid companies increased marketing after Purdue Pharma lawsuit, UW study shows

Original post: Newswise - Substance Abuse Prescription opioid companies increased marketing after Purdue Pharma lawsuit, UW study shows

Newswise — Purdue Pharma is inextricably linked with the opioid crisis.

Owned by the Sackler family, the company is known for aggressively and deceptively marketing opioids —OxyContin in particular — to prescribing doctors. Public scrutiny of Purdue Pharma’s role in the opioid crisis increased sharply in the years following 2007, when the state of Kentucky filed a lawsuit against the company.

In 2015, a judge denied Purdue Pharma’s final request to prevent the case from proceeding to trial and allowed confidential documents from the case to be shared with other potential plaintiffs considering litigation against Purdue Pharma.

New research from the University of Washington examines the behavior of prescription opioid companies following those key events. The United States Supreme Court recently agreed to review Purdue Pharma’s bankruptcy case, temporarily blocking the implementation of a $6 million deal.

After the 2015 lawsuit, Purdue Phama significantly decreased spending to promote OxyContin — its controversial, controlled-release oral formulation of oxycodone hydrochloride. But the UW study, recently published online in Strategic Management Journal, shows the lawsuit had the opposite effect on competing pharmaceutical companies. Competitors increased their spending instead, promoting opioids to physicians previously pursued by Purdue Pharma, including in counties where the opioid crisis was known to be severe.

“We can’t rely on companies to take warnings from lawsuits that happen against other companies,” said David Tan, co-author and associate professor of management in the UW Foster School of Business. “We hope that when one company gets sanctioned, other companies will take that as a warning and try to avoid those kinds of activities. The ideal is that private lawsuits against individual companies have the potential to bring about industry-wide change.

“Unfortunately, I think, rather than serve as a warning to the rest of the industry, this lawsuit created an opportunity for competitors by weakening Purdue’s marketing grasp over its lucrative OxyContin prescribers.”

This study suggests that private actions against individual companies, such as lawsuits and boycotts, can have unintended and counterproductive side effects. In this case, researchers found that when one company reduced its engagement in a questionable practice, its competitors saw an opportunity to fill the void.

The authors identified competing pharmaceutical companies using the U.S. Food and Drug Administration’s Opioid Analgesic Risk Evaluation and Mitigation Strategy. The list includes branded and generic forms of oxycodone, hydrocodone and fentanyl, among others.

Researchers then analyzed data from more than 600,000 prescribers who appeared in the Open Payments database of the Centers for Medicare & Medicaid Services (CMS), which tracks money spent by pharmaceutical sales representatives to promote drugs to physicians.

From 2014 to 2015, Purdue Pharma sales representatives spent $1.5 million on food and beverage during visits to promote OxyContin to prescribers. That number dropped to only $54,000, a 94% decrease, in the years after the lawsuit from 2016 to 2017. Meanwhile, competing companies’ sales representatives increased their spending by 160% from 2016 to 2017.

The CMS database allowed researchers to see which doctors were targeted for promotional visits by pharmaceutical sales representatives, what drugs were promoted during these sales visits and what opioids these doctors prescribed. The authors also examined the average expected health care spending of prescribers’ patients, which helped to control for conditions that may legitimately call for pain management.

After Purdue Pharma reduced its spending to promote OxyContin, competitors increased spending to promote opioids to prescribers of OxyContin specifically. OxyContin contains larger doses per pill, but there are no other real differences between OxyContin and oxycodone – a fact Purdue Pharma was forced to publicly acknowledge as part of a plea deal in a 2007 federal case.

“We don’t see the same kind of jump in competitor promotional spending for oxycodone prescribers in general,” Tan said. “The increase in competitor promotional spending was targeted very specifically at prescribers of the OxyContin brand of oxycodone and at prescribers previously targeted by Purdue’s promotion of OxyContin.”

Researchers also used the database to determine if companies avoided areas known for being epicenters of the opioid crisis, examining how promotional spending by sales representatives varied based on the severity and nature of opioid overdose rates in prescribers’ counties.

“By the time of our study, it had already been well known that the opioid epidemic was out of control and that OxyContin was one of the most heavily abused forms of opioids, especially in regions like Appalachia,” Tan said.

The authors found that the increase in competitor spending occurred regardless of whether prescribers’ counties were above or below the national median in terms of opioid overdose deaths per capita. The increase also occurred when the percentage of opioid overdose deaths was due to prescription opioids as opposed to, for example, heroin or fentanyl. This suggests the increase in spending didn’t reflect an attempt by companies to avoid areas where the opioid epidemic was known to be severe and known to involve prescription opioids.

There have been important developments since the conclusion of the study in 2017, Tan said.  Local governments across the country have filed thousands of opioid-related lawsuits, leading several firms — Purdue Pharma included — to file for bankruptcy.

“That has served as a much more severe warning against the prescription opioid industry and encompasses a wide range of behavior,” Tan said. “Our study covers direct-to-physician promotion, but these lawsuits also extend to other undocumented forms of promotion by prescription opioid firms, such as allegedly funding nonprofit front organizations to influence prescribers’ beliefs about opioids. It took litigation on a national and industry-wide scale to approach something like the power of regulation. Unfortunately, it’s still not technically regulation. It’s still private. But the weight of these settlements has at least tempered behavior on the part of prescription opioid firms.”

Nicole V. West, who earned a doctorate from the UW in 2023 and is now an assistant professor at the University of Texas at Dallas, was a co-author.

For more information, contact Tan at [email protected].

SMART Recovery Meetings for Alcohol Recovery Appeal to People with More Social and Economic Stability and Lower Spiritual Leanings, Compared to Alcoholics Anonymous

Newswise — Certain characteristics of people seeking remission from alcohol use disorder (AUD) are linked to their choice of recovery meeting, a new study suggests. Informal peer recovery groups—mutual-help organizations—play a crucial role for many individuals with AUD or other drug disorders. Such groups are proliferating and differ substantially in approach. SMART Recovery meetings emphasize individual empowerment through learned, evidence-based therapeutic techniques, while Alcoholics Anonymous (AA) meetings offer a 12-step program emphasizing a “higher power” and social support. While AA attendees have been studied, little is known about who engages with SMART Recovery (an acronym for Self-Management and Recovery Training). A better understanding of who engages with differing informal support programs could improve matching and referrals. For the study in Alcohol: Clinical & Experimental Research, investigators in Massachusetts explored the characteristics of those attending SMART Recovery versus AA meetings compared to people attending both and those not seeking support from either group.

From 2019 to 2022, researchers recruited 361 adults with AUD who lived in either New England or San Diego and were starting a recovery attempt: 71 attended SMART meetings only, 73 AA only, 53 both SMART and AA, and 160 neither SMART nor AA. The participants were assessed for demographics, life satisfaction and spirituality, and various resources and barriers (including their confidence about staying sober, commitment to sobriety, and access to social support and other resources). They were also assessed for their histories of substance use and cravings, mental health diagnoses and distress, certain medications, use of treatment and recovery services, experience of negative alcohol consequences, including criminal justice involvement, and more. The investigators used statistical analysis to explore associations between these factors at a single point in time across the four groups (SMART, AA, Both, and Neither).

The four groups differed substantively in their demographics. The SMART-only participants were more likely to be White, married, have higher education and income, and be in full-time employment than the AA attendees. Although participants in all three groups attending meetings had similar levels of AUD symptom severity and psychiatric histories, the SMART attendees reported less heavy and less consequential drinking patterns and reduced spiritual inclinations than those attending AA or Both meetings. Hispanic participants were overrepresented in SMART (possibly because of recruitment in San Diego), while Black participants were almost completely absent. The AA and Both groups reported more alcohol consumption on drinking days (10 drinks) than the SMART and Neither groups (7 drinks). The AA and Both group participants attended many more meetings than the SMART group—possibly reflecting the greater availability of AA meetings and the attendees’ relative severity of alcohol-related problems—and were much more likely to have experienced treatment programs and community recovery services. Nevertheless, the participants of the three mutual-help groups reported comparable access to helpful resources and barriers and similar quality of life, functioning, and well-being. Participants who did not attend meetings had less clinically severe AUD.

Certain aspects of the SMART Recovery philosophy, approach, or content appear to appeal to people with less severe histories of alcohol-related impairment and greater socioeconomic resources and stability. More research is needed on why SMART Recovery does not seem to engage Black participants. The study findings may not apply to broader populations.

Who affiliates with SMART Recovery? A comparison of individuals attending SMART Recovery, Alcoholics Anonymous, both, or neither. J. Kelly, S. Levy, M. Matlack, B. Hoeppner. (pp xxx)

ACER-23-5699.R2

Factors associated with marijuana use among high-risk college students

Newswise — The past decade has seen a significant increase in marijuana use among U.S. college students. This increase has coincided with notable changes in national and local cannabis laws and policies, and perceptions of the associated drug’s risk over the same period. However, cannabis use by students continues to be a public health challenge throughout the country. Universities have long relied on education programs to address these risks; however, many of these programs have limitations and fail to consider some of the modern risk factors for cannabis use among young adults.

A new study led by Benjamin Montemayor, PhD, assistant professor in the Department of Health Behavior at the Texas A&M University School of Public Health, looks into cannabis use patterns, motivations and risk factors for cannabis use among college students at a large public university in the southeastern United States. Results were published in the journal Cannabis.

Although many states have decriminalized or outright legalized cannabis, the drug remains illegal at the federal level and as such is largely banned on university campuses. Despite changes in perceived risks associated with cannabis use, using it can be problematic for college students, especially when used together with alcohol. For example, cannabis use is frequently associated with poorer academic performance and health outcomes such as substance use disorders, with upwards of 70 percent of college students who actively use marijuana meeting the criteria for a potential cannabis use disorder.

To further explore reasons and risk factors for cannabis use among college students, the researchers surveyed 99 students who had violated campus drug use policy. The survey asked students to report how many days of the past month they had used cannabis and how much cannabis (in grams) they typically used per day. The researchers also asked respondents to report their reasons for using cannabis, such as using it to relax or relieve tension, as a sleeping aid, as part of socializing with friends, to experiment or to escape from problems. The researchers finally asked respondents about various risk factors for cannabis use, such as how many students at their university they think also use cannabis, how their friends and families might view them decreasing their cannabis use, perceptions of risks associated with using cannabis regularly, concurrent alcohol co-use, and at what age they started using cannabis. The researchers examined the associations between the quantity of cannabis use per day and the various risk factors, controlling for demographic data such as sex, race and ethnicity, age, years in school and fraternity or sorority membership.

The researchers found that the top three reasons for cannabis use reported by students were to relax or relieve tension, to feel good or get high, and to have a good time with friends. The average age at which respondents reported they started using cannabis was 17 years. On average, students used cannabis on seven out of the past 30 days, with 8 percent reporting daily use of cannabis. The students used more than a quarter of a gram per day, on average, with 40 percent reporting having consumed at least one gram of cannabis per day on days they used. More than half of the sample of students also used alcohol in the past month.

The researchers found that students in the study believe nearly half (47 percent) of all other students on campus also use cannabis and believe their friends or family would think it’s a good idea for them to personally reduce their cannabis use. Finally, the researchers found a low perception of risk overall associated with cannabis use.

Analysis of the data found an association between cannabis use quantity per day and frequency, with students who reported higher quantity of cannabis use per day also reporting more days per month of cannabis use. The study also found a significant association between cannabis use and perceived risk, with more use per day associated with those who had the lowest perceived risk scores. Finally, race and ethnicity were reported to have a significant association with cannabis use, with students who identified as a racial or ethnic minority reporting greater cannabis use.

Modern cannabis interventions fail to address the complicated nature of cannabis in our society partly because of a lack of current information on the diverse ways students are experimenting with cannabis (for example, dabbing and gravity bongs) and the associated hazards. Cannabis has been around for centuries. To be effective, intervention programs should address the specific sociocultural contexts that impact cannabis use, such as culture, religion and values, and the way in which national and state policies conflict and potentially generate permissive norms that cannabis use is allowed on campus.

The findings of this study highlight the need for cannabis intervention programs that address psychosocial risk factors and motivations for cannabis use that are tailored to meet the needs of different racial, ethnic and cultural groups. Better understanding the motivations behind marijuana use and the various factors and perceptions associated with use in college students could help reduce risks presented by drug use.

“Policies are changing, and cannabis use at large is outpacing the rate at which research is coming out,” Montemayor said. “If we fail to adapt our programs to keep up with the way cannabis use has become an ingrained part of our society then we are failing to prioritize the health and safety of the student body.”

Montemayor also cited the Department of Health and Human Service’s recommendation to reclassify cannabis from a Schedule 1 drug, where it has been since the 1970s alongside heroin and crack, to a Schedule 3 drug as one reason why designing and implementing cannabis use programs on campus is as important an issue as it ever has been for universities around the nation.

Cellular Atlas of Amygdala Reveals New Treatment Target for Cocaine Addiction

Newswise — Researchers at University of California San Diego School of Medicine and the Salk Institute for Biological Studies have created a unique, cell-by-cell atlas of the amygdala, a small structure deep within the brain that plays a crucial role in controlling emotional responses to drugs. The findings, published October 5, 2023 in Nature Neuroscience, helped the researchers identify a potential new treatment for cocaine addiction, a disease that is poorly understood at the molecular level and has virtually no approved pharmacological treatments.

“There are some drugs that can help treat other addictions, such as those to opioids or nicotine, but there are currently no safe and effective drugs approved for cocaine addictions,” said co-senior author Francesca Telese, PhD, an associate professor in the Department of Psychiatry at UC San Diego School of Medicine. “These findings help address that problem and could also point to universal molecular mechanisms of addiction that we haven’t understood until now.”

Cocaine is a widely used illicit drug and addiction to cocaine is a major public health concern, associated with a rising number of overdose deaths and a high rate of relapse. Despite the threat cocaine addiction poses, not every person who uses cocaine develops an addiction. According to the National Institute on Drug Abuse, an estimated 4.8 million people used cocaine in 2021, while only 1.4 million people had a cocaine use disorder.

“Some people use cocaine recreationally and never develop an addiction, while others are extremely susceptible to addiction after very little exposure to the drug or may relapse even after years of abstinence,” said Telese “Our long-term goal is to understand why there are these inter-individual differences in drug addiction behavior.”

The researchers studied brain samples from rats that had been allowed to self-administer cocaine for an extended period before being cut off from the drug for a period of abstinence. These samples were obtained from the cocaine brain bank at UC San Diego, established by study co-authors Abraham A. Palmer, PhD, and Olivier George, PhD, both professors in the Department of Psychiatry at UC San Diego School of Medicine.

“The cocaine brain bank is an exceptional resource and was invaluable for this study because it allowed us to study a cohort of rats with a large amount of genetic variety, which mimics the diversity we see in human populations,” said Telese. “Further, using a model of cocaine addiction where rats administered the drug to themselves let us look at the connection between our molecular discoveries and actual addiction behaviors.”

The team used single-cell sequencing to determine what genes were expressed in individual cells from the rats’ amygdala, a part of the brain that is central to processing emotions and is highly active in people with addictions.

“Being able to look at individual amygdala cells from rats with different vulnerabilities to addiction was an asset for our study because we wanted to understand how specific cell populations of the amygdala contribute to addiction development,” Telese added.

To make sense of the large amount of data generated through their sequencing experiments, Telese collaborated closely with bioinformatics expert and co-senior author Graham McVicker, PhD, an associate professor at the Salk Institute of Biological Studies and an assistant adjunct professor in the Department of Cellular & Molecular Medicine at UC San Diego School of Medicine. Jess Zhou, a UC San Diego graduate student working with McVicker, developed the bioinformatics workflow needed to assemble their sequencing data into a molecular atlas of the rat amygdala.

The results revealed never-before-seen connections between addiction behaviors and genes involved in energy metabolism.

“This tells us that energy metabolism may be playing a key role in the activity of neurons in the amygdala and that this effect could be contributing to addiction-like behaviors,” said Telese. “This is a brand-new way of thinking about the molecular biology of cocaine addiction.”

In addition to identifying molecular factors that influence cocaine addiction behaviors, the researchers were able to test a drug in the rats that helped reverse these behaviors by targeting an enzyme involved in both energy metabolism and signaling between neurons.

“The fact that we were able to link our findings at the cellular level to behaviors exhibited in the rats and were even able to modify these behaviors with a drug puts us one step closer to understanding the extremely complex mechanisms in the brain driving addiction and relapse,” added Telese.

The researchers are now working on larger sample-size studies that can help determine how much of the effects they observed were based on preexisting genetics in the rats and how much were based on responses to extensive cocaine usage.

“This research suggests that preexisting genetics may play a much bigger role in addiction than we’ve previously understood,” said Telese. “Unraveling these genetics will be key to improving personalized medicine for addictions. If we don’t understand the risk of relapse in individual people, we can’t fully understand the disease.”

Co-authors of the study include: Giordano de Guglielmo, Marsida Kallupi, Narayan Pokhrel, Apurva S. Chitre, Daniel Munro, Hai-Ri Li and Lieselot LG Carrette at UC San Diego, Aaron J. Ho at the Salk Institute for Biological Studies and Pejman Mohammadi at Scripps Research and University of Washington.

The study was funded, in part, by the National Institutes of Health (grants U01DA050239, F31DA056226, U01DA043799, P50DA037844 and R01GM140287), the Brain and Behavior Research Foundation and the Tobacco Related Disease Research Program (grant T31KT1859 UC).

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Disclosures: Abraham A. Palmer holds a patent related to the use of GLO1 inhibitors (US20160038559, active).

NIH Awards Wake Forest University School of Medicine $10 Million to Study Long-term Opioid Use, Chronic Pain

BYLINE: Myra Wright

Newswise — WINSTON-SALEM, N.C. – Oct. 5, 2023 – Researchers at Wake Forest University School of Medicine have received a five-year $10 million grant from the National Institute on Drug Abuse, part of the National Institutes of Health (NIH), to create a broad research program that will work to reduce opioid-related harms and improve quality of life in patients on long-term opioid therapy.

The grant aligns with the NIH’s Helping End Addiction Long-term (HEAL) initiative. The initiative, which launched in 2018, was created to find scientific solutions to stem the national opioid and pain public health crises.

The project is titled Multilevel Interventions to Reduce Harm and Improve Quality of Life for Patients on Long-term Opioid Therapy (MIRHIQL) and will involve the creation of a national resource center at Wake Forest University School of Medicine.

“Despite the well-known challenges of opioid crises, there is no clinical definition of opioid misuse,” said Meredith C.B. Adams, M.D., associate professor of anesthesiology, biomedical informatics, physiology and pharmacology, and public health sciences at Wake Forest University School of Medicine. “This funding enables us to bring together researchers from across the country to focus on defining opioid misuse, with the long-term goal of our center to develop a better understanding of chronic pain and related factors of long-term opioid use.”

According to Adams, who is a co-principal investigator, there are also certain populations who might benefit from opioids to manage chronic pain which adds to the complexity of the problem.

In 2022, Adams’ team received a $4 million grant from the NIH HEAL initiative to create an Integrative Management of Chronic Pain and OUD for Whole Recovery (IMPOWR): Coordination Center for a network of clinical research centers focused on patient-centered interventions.

Adams’ research team also received $3.5 million in 2022 from the NIH to study how the COVID-19 pandemic impacted opioid use disorder and how the COVID-19 response and mitigation policies impact health outcomes, especially in vulnerable populations.

And earlier this year, Adams was awarded $7.5 million from the NIH’s HEAL Data 2 Action (HD2A) program, which is designed to use real-time data to guide actions and change processes toward reducing overdoses and improving opioid use disorder treatment and pain management.

With the latest funding, the team will create a research community that connects the MIRHIQL network to IMPOWR research centers as well as a larger NIH HEAL network.

“We hope that by defining opioid misuse, we can provide a clear risk vs. harm analysis of long-term opioid therapy for providers,” said Robert W. Hurley, M.D., Ph.D., associate dean for faculty development and professor of anesthesiology, neurobiology, anatomy, and public health at Wake Forest University School of Medicine; executive director of the pain service line at Atrium Health Wake Forest Baptist; and co-principal investigator. “This research will allow us to improve care for patients who are living with chronic pain and decrease opioid misuse and abuse.”