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Gene Discovery Nets FAU Researchers U.S. Patent for Molecular Approach to Treat Addiction

Newswise — According to the Substance Abuse and Mental Health Services Administration, approximately 40 million people in the United States had a substance use disorder in 2020. In addition, over the last decade, the prevalence of opioid addition has increased to epidemic levels. Unfortunately, therapeutic interventions for the treatment of addiction remain limited.

Florida Atlantic University’s Randy D. Blakely, Ph.D., and Maureen K. Hahn, Ph.D., have received a patent from the U.S. Patent and Trademark Office for a novel method to identify therapeutic agents to treat addiction. The invention, related to the fields of pharmacology, medicine, neurology and psychiatry, targets the protein MBLAC1, which the Blakely lab identified as the mammalian form of a gene the group first identified in worms as a modifier of signaling by the neurotransmitter dopamine.

“The majority of drug addiction research has focused on dopamine signaling and how changes downstream of dopamine action eventually lead to compulsive drug seeking,” said Blakely, executive director of the FAU Stiles-Nicholson Brain Institute, the David J.S. Nicholson Distinguished Professor in Neuroscience, and a professor of biomedical science in FAU’s Schmidt College of Medicine. “However, we found evidence in the worm model C. elegans that a gene expressed in glial cells supports the health and function of dopamine neurons and suspected its actions in humans might also relate to addiction.”

Glia are non-neuronal cells in the brain and peripheral nervous system well known to support neuronal metabolism and the rapid transmission of impulses.

“We now know that glial cells support brain function in many more ways, including aspects of the plasticity and drug responses of nearby neurons. Dopamine neurons are no exception,” said Blakely.

Over the past two decades, the Blakely lab has utilized the simple but powerful worm model for its ability to yield insights into the genes and proteins that regulate dopamine signaling. In 2012, the group identified a new gene they named swip-10, as the loss of this gene produces “Swimming-induced paralysis” or Swip. DNA analysis of swip-10 revealed conserved sequences that comprise a Metallo-b-lactamase Domain (MBD), an element that was also found in an uncharacterized human gene termed MBLAC1.

“Metallo-b-lactamases are well known to microbiologists for the ability of bacteria to degrade antibiotics such as penicillin and thereby contribute to antibiotic resistance,” said Blakely. “However, in more complex organisms, MBD has been repurposed to digest many other molecules. So, we suspected that drugs targeting human MBD-containing proteins would likely have non-microbial effects, perhaps even medically relevant ones.”

Indeed, prior to the Blakely lab identifying swip-10, scientists studying addiction were learning that the beta-lactam antibiotic ceftriaxone could diminish several brain changes that arise with chronic use of addictive drugs. What they didn’t know was what protein ceftriaxone bound to in the brain. In 2018, the Blakely lab reported that the protein made by the MBLAC1 gene is a major, if not exclusive, target for ceftriaxone. More recent data from mice engineered to eliminate MBLAC1 protein expression demonstrate a requirement for the protein in the ability of cocaine to establish long-term behavioral changes that reflect brain alterations scientists believe contributes to the drug’s abuse liability.

Remarkably, the Blakely lab has discovered that loss of swip-10 also causes age-dependent neurodegeneration.

“We think these findings link to recent studies implicating MBLAC1 as a contributor to risk for certain forms of Alzheimer’s disease as well as the ability of ceftriaxone to display neuroprotection in animal models,” said Hahn, co-inventor on the patent and a research associate professor of biomedical science in FAU’s Schmidt College of Medicine. “We are very excited that what began as a simple genetic screen using worms may be leading us to insights into a number of different brain disorders.”

– 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.

Is digital media use a risk factor for psychosis in young adults?

Newswise — On average, young adults in Canada spend several hours on their smartphones every day. Many jump from TikTok to Netflix to Instagram, putting their phone down only to pick up a video game controller. A growing body of research is looking into the potential dangers of digital media overuse, as well as potential benefits of moderate digital media use, from a mental health standpoint.

A recent McGill University study of 425 Quebecers between the ages of 18 and 25 has found that young adults who have more frequent psychotic experiences also tend to spend more time using digital media. Interestingly, the study, which surveyed the participants over a period of six months, also found that spending more time on digital media did not seem to cause any change in the frequency of psychotic experiences over time, said lead author and psychiatry resident at McGill, Vincent Paquin.

By “psychotic experiences,” the researchers refer to a range of unusual thoughts and perceptions, such as the belief of being in danger and the experience of hearing and seeing things that other people cannot see or hear. These experiences are relatively common, affecting about 5% of young adults.

“Our findings are reassuring because they do not show evidence that digital media can cause or exacerbate psychotic experiences in young people,” said Paquin. “It is important to keep in mind that each person is different. In some situations, digital media may be highly beneficial for a person’s well-being, and in other cases, these technologies may cause unintended harms.”

Accessing mental health services through digital media

The researchers hope their findings will help improve mental health services for young people. By better understanding the types of digital contents and activities that matter to young people, mental health services can be made more accessible and better aligned with individual needs, they say.

“It is important for young people, their families, and for clinicians and policymakers to have scientific evidence on the risks and benefits of digital media for mental health, Paquin said. “Considering that young adults with more psychotic experiences may prefer digital technologies, we can use digital platforms to increase their access to accurate mental health information and to appropriate services.”

Alcohol makes you more likely to approach attractive people but doesn’t make others seem better looking: Study

Original post: August 30, 2023 12:05 pm Newswise - Substance Abuse Alcohol makes you more likely to approach attractive people but doesn't make others seem better looking: Study

Newswise — PISCATAWAY, NJ — It’s “liquid courage,” not necessarily “beer goggles”: New research indicates that consuming alcohol makes you more likely to approach people you already find attractive but does not make others appear more attractive, according to a report in the Journal of Studies on Alcohol and Drugs.

The conventional wisdom of alcohol’s effects is that intoxication makes others seem better looking. But, according to the new study, this phenomenon has not been studied systematically. Earlier research typically had participants simply rate other’s attractiveness while sober and while intoxicated based on photos.

But this new study added a more realistic element: the possibility of meeting the people being rated.

To conduct the research, lead investigator Molly A. Bowdring, Ph.D., of the Stanford Prevention Research Center in Palo Alto, Calif. (affiliated with University of Pittsburgh at the time of this study), and her dissertation advisor, Michael Sayette, Ph.D., brought in 18 pairs of male friends in their 20s to the laboratory to rate the attractiveness of people they viewed in photos and videos.

Participants were told that they may be given the opportunity to interact with one of those people in a future experiment. After providing attractiveness ratings, they were asked to select those with whom they would most like to interact.

Pairs of men came into the lab on two occasions. On one occasion, both men received alcohol to drink (up to about a blood alcohol concentration of .08%, the legal limit for driving in the United States) and on the other occasion, they both received a nonalcoholic beverage. The researchers had friend pairs in the lab to mimic the social interactions that would typically take place in a real drinking situation.

The researchers did not find evidence of beer goggles: Whether or not participants were intoxicated had no effect on how good looking they found others. “The well-known beer goggles effect of alcohol does sometimes appear in the literature but not as consistently as one might expect,” observes Sayette.

However, drinking did affect how likely the men were to want to interact with people they found attractive. When drinking, they were 1.71 times more likely to select one of their top-four attractive candidates to potentially meet in a future study compared with when they were sober.

Alcohol may not be altering perception but rather enhancing confidence in interactions, giving the men liquid courage to want to meet those they found the most attractive, something they may be much less likely to do otherwise.

These results could have implications for therapists and patients, the authors note.

“People who drink alcohol may benefit by recognizing that valued social motivations and intentions change when drinking in ways that may be appealing in the short term but possibly harmful in the long term,” says Bowdring.

Alcohol makes you more likely to approach attractive people but doesn't make others seem better looking: Study

But this new study added a more realistic element: the possibility of meeting the people being rated.

These results could have implications for therapists and patients, the authors note.

HEAL expands naloxone access to turn the tide on overdose deaths

Original post: August 30, 2023 11:50 am Newswise - Substance Abuse HEAL expands naloxone access to turn the tide on overdose deaths

BYLINE: Elizabeth Chapin

Newswise — LEXINGTON, Ky. (Aug. 29, 2023) — Aug. 31 marks International Overdose Awareness Day, a time when attention is directed toward raising awareness about opioid overdose and ways to reverse the deadly effects.

One such way is naloxone, a medication that has become more available throughout Kentucky in recent years with the University of Kentucky’s HEALing Communities Study playing a significant role.

Naloxone is a medication that when given in time can quickly reverse the effects of opioids and help restore breathing in someone who is experiencing an overdose.

Increasing access to naloxone is one of the evidence-based strategies implemented by the HEALing Communities Study to reduce opioid deaths in Kentucky. Launched in 2019, the $87 million study is focused on 16 counties hardest hit by the opioid epidemic. The goal is to develop sustainable solutions that can be scaled across the Commonwealth.

So far, the study has helped thousands of Kentuckians get access to the lifesaving medication. Since the first unit of naloxone was distributed in April 2020, more than 86,000 units of naloxone have been distributed across the 16 counties participating in HEAL.

To put it into perspective — in 2019, the year before the HEAL intervention was launched, that number was just about 7,000, says Trish Freeman, Ph.D., a professor in the UK College of Pharmacy who leads the HEAL Prevention Team and coordinates HEAL’s naloxone education and distribution efforts in Kentucky.

In 2022, 2,127 Kentuckians died from a drug overdose, with 90% involving opioids. While Kentucky’s overdose death rate decreased by 5% last year, it’s still among the highest in the nation.

“No one should die from an overdose and naloxone is one of the most effective ways to intervene and save a life,” said Freeman. “By getting naloxone into the hands of more Kentuckians, we are saving lives today while informing the blueprint for the most effective way for communities to do so going forward.”

Most of the naloxone distributed by HEAL is delivered through partnerships with various community organizations and agencies including treatment, criminal legal system, social service and public health programs.

The study, which is broken down into two waves of eight counties each, has partnered with 245 agencies across all 16 counties. The HEAL Implementation Team, led by Hannah Knudsen, Ph.D., a professor in the UK College of Medicine, works hand in hand with partner agencies to provide the support needed to implement overdose education and naloxone distribution with their clients.

Knudsen’s team of implementation facilitators meet with a wide range of agencies to share information about HEAL’s overdose education and naloxone distribution program and then work with agencies to establish a workflow and provide technical assistance to ensure effective implementation.

The HEAL Prevention team operates a naloxone distribution hub in the Center on Drug and Alcohol Research for partner agencies that also includes training materials, because education about overdose and how to use the medication is required. Under a standing order agreement, HEAL co-investigator Michelle Lofwall, M.D., professor in the UK College of Medicine, signs the order as the physician of record for all naloxone distributed.

The agency partnerships reach those at highest risk for overdose, especially within the criminal legal system, where HEAL has partnered with jails and prisons, drug court, pretrial services, police departments, and probation/parole programs.

The risk of overdose is increased when people are released from a correctional facility because tolerance for the drug can decrease significantly during a period of abstinence. After release, an attempt to use the same amount of opioid may lead to overdose or death, says Carrie Oser, Ph.D., professor in the UK College of Arts and Sciences and co-lead of the HEAL Criminal Legal System Team.

Most jails partnering with HEAL offer naloxone as part of the discharge process. Some, including the Madison County and Jefferson County detention centers, have opted to install “vending machines” in lobbies or discharge areas. The digital kiosks streamline tracking and mandatory training.

“The agencies we work with choose what works best for them given their unique staffing and organization needs. The most important thing is that people who are discharged are getting access to naloxone during this critical time,” said Oser.

Beyond agency distribution, naloxone is dispensed through the HEALing Communities Study comes from its own outreach team. HEAL prevention specialists reach people directly at venues like community events, social service agencies, businesses, schools and addiction treatment and recovery facilities.

In addition to educating people on how to recognize an overdose and properly administer naloxone, the team addresses a lot of myths and misperceptions people have.

“People need to know it’s safe to use on anyone and won’t hurt someone who isn’t overdosing,” said Gabi Deaton, a HEAL prevention specialist coordinator. “We also talk about the Good Samaritan law, which protects people from prosecution when they report a drug overdose. Our goal is to make sure they’re confident, equipped and ready to intervene in the case of an opioid emergency if they ever need to.”

Deaton serves as the prevention specialist for Campbell County and organizes the outreach efforts of her colleagues assigned to the seven other counties in the HEAL’s second wave.

While the team generally visits locations with people at higher risk of overdose, they reach a larger cross section of the public compared to the agencies. Their visibility helps reduce the stigma surrounding opioid use disorder and ensure that more family members, friends and bystanders are carrying naloxone.

Deaton says people sometimes reach out to thank her after the naloxone she gave them is used to save a life. There are too many to remember them all, but she still keeps in touch with some who are now in recovery.

Soon, it will be easier to access naloxone nasal spray products, including brand name Narcan and its generic counterparts. These products were recently approved by the U.S. Food and Drug Administration for sale over the counter (OTC) and should be available in pharmacies and other retail stores that sell OTC products by mid-October.

Overdose education and naloxone distribution by a wide range of agencies will likely still be needed to ensure that cost is not a barrier and that people learn now to effectively use naloxone to respond to an overdose.

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number UM1DA049406. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

As the state’s flagship, land-grant institution, the University of Kentucky exists to advance the Commonwealth. We do that by preparing the next generation of leaders — placing students at the heart of everything we do — and transforming the lives of Kentuckians through education, research and creative work, service and health care. We pride ourselves on being a catalyst for breakthroughs and a force for healing, a place where ingenuity unfolds. It’s all made possible by our people — visionaries, disruptors and pioneers — who make up 200 academic programs, a $476.5 million research and development enterprise and a world-class medical center, all on one campus.

In 2022, UK was ranked by Forbes as one of the “Best Employers for New Grads” and named a “Diversity Champion” by INSIGHT into Diversity, a testament to our commitment to advance Kentucky and create a community of belonging for everyone. While our mission looks different in many ways than it did in 1865, the vision of service to our Commonwealth and the world remains the same. We are the University for Kentucky.

Adapting Ritalin(r) to tackle cocaine abuse

Newswise — Cocaine use continues to be a public health problem, yet despite concerted efforts, no drugs have been approved to resolve cocaine addiction. Research suggests that the attention-deficit/hyperactivity disorder drug methylphenidate (MPH; Ritalin®) could serve as a cocaine-replacement therapy, but clinical results have been mixed. Although several labs have produced MPH derivatives for testing, parts of the molecule remained chemically inaccessible. Now, researchers reporting in ACS Central Science have cleared that hurdle.

According to the Centers for Disease Control and Prevention, more than 5 million Americans reported actively using cocaine in 2020, and almost 25,000 Americans died of a cocaine-related overdose in 2021. Although small-molecule drugs have proven effective in treating other drug addictions — for example, methadone as a therapy for heroin abuse — no such medication exists for cocaine abuse. MPH has been considered a potential treatment because it behaves similarly to the illicit drug, increasing dopamine levels in the brain by blocking dopamine reuptake. Additionally, clinical studies have shown that MPH has a lower risk of abuse than cocaine. Although studies in animals have shown that MPH can reduce cocaine dependence, studies in humans have offered more mixed results. Thus, researchers are developing libraries of MPH derivatives, searching for molecules with improved clinical efficacy. Until recently, however, it was difficult to create derivatives of one chemical component of MPH: its piperidine ring. W. Dean Harman and colleagues wanted to address this shortcoming by taking an organometallic approach.

Using a tungsten-based reagent, the researchers synthesized a library of MPH analogues specifically modified at the piperidine ring with a variety of chemical groups. And whereas MPH is a mixture of four isomers — otherwise identical molecules with small structural differences — the new method allowed the researchers to synthesize and purify compounds that were predominantly comprised of a single isomer. This could be important in clinical studies, as different isomers of some drugs can have significant impacts on therapeutic efficacy or safety. Whether any of these MPH analogues prove effective against cocaine addiction remains to be determined, but the researchers noted that the new protocol could be widely applicable to pharmaceutical development, given the ubiquity of the piperidine ring in small-molecule drugs.

The authors acknowledge funding from the National Institute of General Medical Sciences of the National Institutes of Health and the National Science Foundation.

The paper’s abstract will be available on Aug. 30 at 8 a.m. Eastern time here: http://pubs.acs.org/doi/abs/10.1021/acscentsci.3c00556

The American Chemical Society (ACS) is a nonprofit organization chartered by the U.S. Congress. ACS’ mission is to advance the broader chemistry enterprise and its practitioners for the benefit of Earth and all its people. The Society is a global leader in promoting excellence in science education and providing access to chemistry-related information and research through its multiple research solutions, peer-reviewed journals, scientific conferences, eBooks and weekly news periodical Chemical & Engineering News. ACS journals are among the most cited, most trusted and most read within the scientific literature; however, ACS itself does not conduct chemical research. As a leader in scientific information solutions, its CAS division partners with global innovators to accelerate breakthroughs by curating, connecting and analyzing the world’s scientific knowledge. ACS’ main offices are in Washington, D.C., and Columbus, Ohio.

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An Emerging Class of Opioids Are Leading to Severe Overdoses, Cardiac Arrest, and Treatment Challenges

Original post: August 29, 2023 9:00 am Newswise - Substance Abuse An Emerging Class of Opioids Are Leading to Severe Overdoses, Cardiac Arrest, and Treatment Challenges

EMBARGO LIFTS AUGUST 29, 11AM EST

Author: Alex Manini, MD, MS, Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai, Director of the Center for Research on Emerging Substances, Poisoning, Overdose, and New Discoveries

Journal: JAMA Open – Embargo lifts August 29, 2023, 11 am EST

Bottom Line: A subclass of opioid drugs called nitazenes are now emerging in the illicit opioid supply in the United States and are more potent than even fentanyl. These nitazenes add a layer of complexity to the dangers of illicit drug use, leading to a significantly increased rate of cardiac arrest in overdose cases and significantly higher doses of naloxone for in-hospital treatment when compared to fentanyl overdoses.

Why This Study Is Unique: This is the first human study to show the clinical effects of new potent opioids such as brorphine and nitazene class drugs.

Why This Study Is Important: This study is the first to identify the impact of new illicit opioids, including adverse consequences from nitazenes, such as frequent cardiac arrest, and higher dosage of naloxone for treatment.

How the Study Was Conducted: Researchers analyzed 2,298 patients admitted with opioid overdoses to emergency departments across the country between 2020 and 2022.

Study Results: Overdoses from the more potent opioids needed on average 1.33 doses of naloxone in-hospital, compared to 0.36 average doses for fentanyl overdose. In addition, 100 percent of overdoses on one nitazene drug (metonitazene) had a cardiac arrest.

What This Means for Clinicians/Hospitals: Clinicians in the United States should be aware of new potent opioids in the illicit drug supply and be prepared for higher naloxone dosing requirements.

Quotes:

“Given the alarmingly high cardiac arrest rate for nitazene overdose, this study should energize harm-reduction policies. And given the emergence of dangerous toxic drugs in the illicit opioid supply in the United States, future research should examine clinical outcomes from new potent opioids as the supply continues to evolve,” says Alex Manini, MD, MS, Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai.

About the Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals” and by U.S. News & World Report‘s® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report‘s® “Best Hospitals” Honor Roll for 2023-2024.

Understanding the Surge in Cannabis Use among Pregnant and Postpartum Women in the US

Original post: August 25, 2023 9:05 am Newswise - Substance Abuse Understanding the Surge in Cannabis Use among Pregnant and Postpartum Women in the US

BYLINE: Greg Bruno

Newswise — Pregnant and recently postpartum women who suffer with mental health disorders may be vulnerable to using cannabis to self-medicate, according to a Rutgers-led study.

In a nationally representative survey, Qiana L. Brown, an assistant professor at the Rutgers School of Social Work, examined the relationship between mental health disorders, cannabis use and cannabis use disorder (CUD) among pregnant and postpartum women in the US. The findings were published in the journal Drug and Alcohol Dependence.

“Before this study, we didn’t know much about the associations between cannabis use, CUD and specific mental health disorders, such as bipolar disorder or specific phobia, among pregnant and postpartum women in the US,” Brown said.

“Most prior research grouped mental health disorders into general classes, such as any mood disorder or any anxiety disorder, without examining the relationship between specific types of mood and anxiety disorders and cannabis use and CUD during and after pregnancy.

Despite public health messaging encouraging women to abstain from using cannabis during pregnancy and while breast feeding, the prevalence of cannabis use by women of reproductive age has been increasing.

In a previous study by Brown and colleagues published in the Journal of the American Medical Association, the prevalence of past month cannabis use increased 62 percent among pregnant women and 47 percent among nonpregnant women of reproductive age from 2002 to 2014.

In studies using smaller sample sizes, “pregnant and postpartum women used cannabis to relieve stress, anxiety and cope with mental health symptoms, which may indicate that they are self-medicating mental health conditions,” the researchers noted.

“However, little is known about the mental health correlates of cannabis use and CUD among pregnant and postpartum women at the national level.” Given that most states have legalized cannabis for medical or recreational use, Brown said it’s important to understand mental health correlates of cannabis use and CUD among this population at the national level.

To address this research gap, Brown and colleagues from Columbia University, Washington University in St. Louis and École Polytechnique Fédérale de Lausanne in Switzerland analyzed the responses of 1,316 women in a national survey focused on drug and alcohol use and associated physical and mental disabilities. The sample included 414 women who were pregnant at the time of the interview and 902 postpartum women (pregnant in the past year).

What they found was a clear association between general classes of mental health disorders, cannabis use and CUD. For instance, pregnant and postpartum women who had any mood, anxiety or posttraumatic stress disorders in the past year or any lifetime history of personality disorder had higher odds of cannabis use and higher odds of CUD in the past year than women without a history of a given mental health disorder.

However, when mental health disorders were disaggregated into specific types, some mental health disorders were associated with cannabis use, but not CUD and vice versa. For example, while persistent and major depressive disorders were associated with both past year cannabis use and CUD, bipolar disorder was only associated with past year cannabis use, and not CUD (after accounting for potential confounding factors).

Additionally, cannabis use and CUD didn’t share common correlates regarding anxiety disorders. Social anxiety and panic disorders were associated with increases in cannabis use, but not CUD, while specific phobia was associated with increases in CUD and not cannabis use.

Previous studies that have examined the relationship between mental health disorders, cannabis use and CUD among pregnant or postpartum women primarily focused on patient- samples, not women from the general US population, used smaller samples sizes or focused on a limited number of mental health disorders.

In total, the researchers examined three general classes of mental health disorders and 12 specific types of mental health disorders and their relationship with cannabis use and CUD.

“This level of specificity and the generalizability of our results can help inform tailored treatment and population-level preventive interventions,” said Brown.

Anesthesiologists should play bigger role in perioperative care of people with Substance Use Disorders

Original post: August 24, 2023 10:13 am Newswise - Substance Abuse Anesthesiologists should play bigger role in perioperative care of people with Substance Use Disorders

Newswise — August 24, 2023 – As use and misuse of alcohol, opioids, and psychostimulants continues to increase, anesthesiologists can become a more integral part of the care team managing patients with a Substance Use Disorder (SUD), according to a series of three articles published in the September issue of Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society. The journal is published in the Lippincott portfolio by Wolters Kluwer.

The articles provide an overview of SUDs specific to the anesthesiologist and offer insights into pain management for opioid use disorder and exposure to psychostimulants. “The series is timely because the fundamental philosophies that guide management of patients with SUDs have evolved rapidly over the past decade. How can anesthesiologists begin to more adequately address the unmet needs of patients with SUDs in the perioperative period?” ask Akash Goel, MD, MPH, Department of Anesthesiology and Pain Medicine, University of Toronto, and Wiplove Lamba, MD, Department of Psychiatry University of Toronto, in an editorial overview of the series.

Recommendations for expanded involvement in managing patients with SUDs

As management of SUDs has evolved, anesthesiologists have become increasingly recognized as necessary to that management. The series ask readers to look at SUDs and SUDs treatment through the lens of a wide range of biopsychosocial factors and encourages a broader approach to effective disease management. For example, one article points out how discontinuing buprenorphine, a commonly used analgesic for reducing cravings, may actually increase opioid use during the perioperative period.

Goel and Lamba offer recommendations for how anesthesiologists can contribute meaningfully to improving outcomes for patients with a SUD. Trauma-informed patient care is critical. For example, during the pre-operative period understanding through direct discussion with a patient how their previous traumatic experiences might inform their perioperative experience and the need for a personalized pain management plan. Increased collaboration with patients, experts in Addiction Medicine and Psychiatry, patient advocacy groups, primary care providers, and other care partners is also key. In addition, with advances in treatment and the growing importance of socio-demographic factors, educational assets for anesthesiologists should be updated with content specific to addiction. Finally, the authors urge anesthesiologists to start viewing their role as one beyond pain management. Greater involvement in harm reduction interventions and surgical rehabilitation are two suggested areas.

Need for outcomes measurement to assess new approaches

The continuing evolution of both our understanding of addiction and substance abuse, and SUD management make high-quality studies and randomized controlled trials challenging. Objectives of these new approaches are to prevent relapse, reduce harm, minimize pain, and improve the overall well-being of people with SUDs. Goel and Lamba are proposing a system where relevant decision makers (patients, substance use experts) and appropriate stakeholders are involved in the policies and decisions that affect persons with SUDs.

Read the Substance Use Disorders issue of Anesthesia & Analgesia.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

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About Anesthesia & Analgesia

Anesthesia & Analgesia is the is the official journal of the International Anesthesia Research Society. The journal provides the practice-oriented, clinical research needed to keep current and provide optimal care to patients. Each monthly issue includes peer reviewed articles on the latest advances in drugs, preoperative preparation, patient monitoring, pain management, pathophysiology, and many other timely topics.

About the International Anesthesia Research Society

The International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes more than $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia-related practice; sponsors the SmartTots initiative in partnership with the FDA; and publishes the monthly journal Anesthesia & Analgesia and its companion journal, A&A Practice, semi-monthly.

About Wolters Kluwer

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

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.

For more information, visit www.wolterskluwer.com, follow us on LinkedIn, Twitter, Facebook, and YouTube.

Overlooked part of brain could play critical role in addiction recovery

Newswise — INDIANAPOLIS—Researchers from Indiana University School of Medicine have discovered a neglected brain region that could play a critical role in how likely a person with drug use disorders is to relapse, even after a long withdrawal period. Their findings were published recently in Biological Psychiatry.

“Past studies in the field of addiction research have focused on the medial prefrontal cortex, which is the part of the brain that controls decision making, but no effective prevention or treatment for drug relapse is available,” said Yao-Ying Ma, MD, PhD, associate professor of pharmacology and toxicology and an investigator with the Stark Neurosciences Research Institute at IU School of Medicine. “We focused instead on the supplementary motor cortex, and found this area plays a bigger role in the risk of relapse. It could be a new target for therapeutics to prevent relapse.”

Researchers studied cocaine-seeking behaviors in animal models, measuring excitability levels in the motor cortex after 45 days of withdrawal. They found hyperexcitability in the motor cortex was increased at this point and used an intervention to calm the excitability taking place in that part of the brain.

“One of the biggest challenges for patients with addiction is preventing relapse,” Ma said. “We know they need medication, community involvement, psychological support and other resources to help, but for many people who go back to take a drug, it just feels like an automatic behavior. If we can understand whether addiction behavior is subconscious or conscious behavior, we can find better ways to treat and prevent addiction and relapse.”

The supplementary motor cortex is typically known for directing how the body moves, so Ma said the finding that it plays a big role in addiction is novel and exciting.

“This brain region has never really gotten too much attention in addiction research, so we’re excited about this finding and how it can change the way we treat addiction by using less invasive methods, such as transcranial magnetic stimulation, as well as the trajectory of our work moving forward,” Ma said.

In the future, the team will study the effect of other addictive substances to see if the supplementary motor cortex is involved in other types of drug use disorders, such as opioid and alcohol use disorders.

The first author of the study, Donald Huang, was Ma’s PhD student. Huang recently received his PhD in Medical Neuroscience from IU School of Medicine and now works as a postdoctoral researcher at the University of Chicago.

About Indiana University School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.