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Scientists join the fray in fight against US opioid epidemic

Chemists and engineers are turning their attention to trying to alleviate some of the suffering caused by the opioid epidemic ravaging the US, driven by an unprecedented surge in deaths from fentanyl and other synthetic opiates.

Overall, opioid-related deaths in the US spiked from approximately 18,500 in 2007 to more than 47,000 a decade later, according to the US National Institutes of Health. Overdose deaths linked to synthetic opioids in the country rose more than 45% between 2016 and 2017, the country’s Centers for Disease Control (CDC) estimates. A new CDC report identifies fentanyl as the deadliest drug in the country, causing more than 18,300 deaths in 2016.

Synthetic opioids such as fentanyl are very long-lasting compared with traditional narcotics of abuse such as morphine and heroine. Doses of the current antidotes have not always been potent enough to fully counter the effects of fentanyl, according to Saadyah Averick from the Allegheny Health Network Research Institute in Pennsylvania. He discussed his work to develop single-dose, longer-lasting opioid antidotes using polymer nanoparticles at the American Chemical Society’s spring meeting in Orlando, Florida on 1 April.

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A Prescription for Change

Amidst the ongoing opioid epidemic in the United States, the assertion that “addiction is a disease” continues to dominate the public discourse surrounding substance use and drug policy. While the brain disease model of addiction is often credited with clearing the way for a more empathetic approach to treating and policing drug use, the work of many psychological scientists suggests that addiction may arise from the same basic psychological mechanisms that allow us to discover a passion for jogging, adapt to our environment, and feel loved.

When studies conducted in the 1960s indicated that lab rats would self-administer drugs even until death, many researchers took it as evidence of the inexorable appeal of substances like morphine and heroin. A decade later, Bruce Alexander’s series of “rat park” experiments at Simon Fraser University in British Columbia, Canada would turn this claim on its head.

Alexander’s rats, which were kept isolated in small metal cages with little else to do beyond sleep, eat, and wait, also filled their time by consuming large quantities of drugs. Not so for rats raised in a less traditional lab environment, however. Free to roam within the walls of a large plywood box painted with a forest scene and filled with others of their kind, more often than not the rats chose running in an exercise wheel, climbing wooden towers and tin cans, mating, and bonding with offspring over the temptation of a morphine drip. And when they did choose to partake, the social rats consumed far less than their isolated counterparts.

“They forgot to tell us the importance of the environment,” behavioral neuroscientist Carl Hart, chair of the Department of Psychology at Columbia University, said of earlier addiction studies. “They forgot to tell us that the rats or primates only had that lever leading to the drug administration, and if that’s the only thing they have in that cage, why are we surprised that’s the activity in which they engaged?”

Since learning about the findings of these early addiction studies as an undergraduate student at the University of Maryland in the 80s, Hart — an advocate for science-based drug policy who’s appeared everywhere from “Real Time with Bill Maher” to “The O’Reilly Factor” — has extended Alexander’s rat park findings to human participants. When offered a choice between $5 at the end of a study and a hit of crack cocaine worth more than $5 right then and there, only half of people known to be addicted to cocaine chose the drug, Hart said. In a similar study of 13 recreational methamphetamine users, participants abstained at even higher rates, choosing $5 over self-administering drugs 59% of the time over the course of five 2-day trials. When the incentive was raised to $20, they chose the substance over cash in just 17% of trials.

These findings, while observed in a small pool of participants, suggest that providing people with attractive alternatives removes much of the incentive to use, Hart said. Extrapolated to the real world, alternatives might not only increase access to meaningful employment and mental healthcare for individuals with substance use issues, but could also change the way society conceives of drug use.

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College Kids Walking on Campus

Opioid addiction diagnosis and treatment climbs with Medicaid expansion

More low-income people addicted to opioids are getting diagnosed and treated with effective medication as a result of the Affordable Care Act, a new study suggests

Under the ACA, also known as Obamacare, some U.S. states expanded coverage through Medicaid – the joint federal and state insurance program for the poor – starting in 2014. While previous studies have linked Medicaid expansion to gains in the number of people treated for substance use disorders, the current study offers fresh evidence that the law helped to improve access to buprenorphine, a drug for treating opioid addiction.

“When people get signed up for Medicaid, it increases the likelihood that they will seek all types of medical care including more visits to primary care doctors, and even when patients are not explicitly seeking care for opioid addiction, the greater contact with the health system creates more opportunities for screening and diagnosis,” said lead study author Brendan Saloner of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

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Katie Konrad WCPO

‘We’ve done a better job of keeping more people alive and getting more people into treatment’

The federal government has been stepping up funding to Ohio to fight the opioid crisis, and Tom Synan of the Hamilton County Heroin Coalition can see the positive impact.

“We’ve done a better job of keeping more people alive and getting more people into treatment.” Synan told WCPO.

According to a new report by the Bipartisan Policy Center, federal funding in Ohio addressing the opioid crisis nearly doubled from 2017 to 2018. It increased from about $120 million to more than $220 million.

That’s nearly $350 million in two years from 57 different federal departments, and most of it went to Hamilton County (Cincinnati), Franklin County (Columbus), Cuyahoga County (Cleveland) and Montgomery County (Dayton).

“You’re seeing more money from the federal side and it definitely helps. We need that support,” said Synan, who is police chief in Newtown. “Locally, where some of that federal money helps us is the quick response team. It paid for a portion of that.”

Federal funding also helps run the county’s engagement center, which serves people who have recently overdosed. Across the state, 85 percent of all federal money is spent on treatment, recovery and prevention.

“If we didn’t have that federal support, we’d be spinning our wheels on the front end. So that federal money is important,” Synan said.

Like Synan, Katie Konrad is on the front line of the fight against opioid addiction. Konrad was an addict herself.

“I hit rock bottom, honestly, a couple years ago. I woke up in a bedroom and I had my three children with me and my car had been repossessed,” Konrad said.

Konrad abused prescription Adderall, but she’s been clean for 17 months and has been working 12 months as a patient access specialist at BrightView.

“Some days it’s busy from 7 a.m. until we leave at 7 p.m,” Konrad said.

Konrad takes calls from patients who are struggling with addiction. She knows what they’re talking about.

“I love helping people. Every patient I talk to is a gift, honestly, because I feel like I can shape someone’s life just by saying, ‘Hello, how can I help you?’ ”

Synan and Konrad say understanding addiction is key to helping addicts.

“It’s not willpower. It’s not character. It really is a transition of the brain,” Synan said.

Synan says one area that needs more attention is research. Only 3 percent of federal money in Ohio goes to researching addiction.

“I think one of the things we’re lacking most in this is the science and the medical side of it. That’s going to take funding and that’s going to take research,” Synan said.

For the present, Konrad says it’s also important that there’s enough treatment available to addicts and that they commit themselves to recovery, like she did.

“I think what we’re doing there at BrightView is working, but the patient has to want it, too. It’s not going to work for somebody who does not put their heart into treatment,” Konrad said.

It’s hard, but she’s living proof it can be done.

“There’s lots of addiction in Hamilton County. There’s also lots of recovery,” she said.

“We do get better. It doesn’t matter what substance we’re using. If you get your mind right and you get the support you need and the treatment that works best for you, you can get better.”

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In Most States, Insurance Won’t Cover Addiction Treatments

In a finding that brings bad news as America struggles with an opioid epidemic, a new report shows that only four states provide adequate insurance coverage for addiction treatment.

“We are calling on states to ensure health plans cover the full range of effective addiction treatments and address the serious gaps identified in this report,” said report author Lindsey Vuolo. She is director of health law and policy at Center on Addiction, in New York City.

“Improving insurance coverage for addiction treatment is essential to resolving the opioid crisis,” Vuolo stressed.

In the report, the researchers analyzed addiction treatment benefits in health insurance plans sold across the United States in 2017. The investigators found that more than half of states offered a plan that did not comply with the Affordable Care Act’s requirements to cover addiction treatment.

In addition, 20 percent of states offered a plan that violated a federal law that requires insurance plans to pay for addiction treatment the same way they cover treatment for other chronic diseases, like diabetes or cancer.

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Women And Alcoholic Drink

Are Women Less Likely To Seek Help For Alcohol Abuse?

A new study found that women were significantly more likely than men to believe their alcohol abuse would resolve on its own. A recent study found that drinking affects women’s bodies differently than men—and now a new study shows that women approach getting help for drinking differently as well.

Iowa Now reported that a new study from the University of Iowa reveals blatant gender differences, and confirmed the need for gender-disparate studies on health issues. Women were significantly more likely than men to believe their alcohol abuse would resolve on its own, with 47% of women responding affirmatively versus 23% of men.

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Senator Rob Portman

At Bipartisan Policy Center Event, Portman Highlights Progress in Combating the Opioid Crisis

WASHINGTON, D.C. – At a Bipartisan Policy Center event, U.S. Senator Rob Portman (R-OH) highlighted the progress he is seeing in Ohio and around the country in combating the opioid crisis and his efforts on the federal level by enacting the Comprehensive Addiction & Recovery Act (CARA), the 21st Century CURES Act, and the STOP Act to make a difference.  Portman made clear we cannot let up and must continue to make the federal government a better partner in this effort.  He also highlighted next steps, including his CARA 2.0 Act, that Congress should take to strengthen the federal response.

During his remarks, Portman praised a new Bipartisan Policy Center report on the federal opioid funding and the issues it identified like sustainability of funding, the need for greater state and local flexibility, and greater coordination at the federal, state and local levels.  These are concerns Portman has heard about in Ohio and he will continue to work with key stakeholders to ensure we are implementing a comprehensive approach to addressing this crisis.

Video of Portman’s remarks can be found here.

Link to original press release here.

 

Doctor and Baby

Pregnancy and Addiction: Overlooked and Undertreated

If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop.

With one in three individuals with opioid use disorder passing through the criminal justice system annually, court dockets across the country are overflowing with cases of illegal behavior fueled by addiction. Though such cases wrangle with the complexities of punishing individuals afflicted with what is increasingly seen as a disease that erodes free will, they are the bread and butter of the legal system.

However, the recent Pennsylvania Supreme Court case known as In the Interest of L.J.B. adds another level of intricacy to the court’s decision-making process. The question asked in the case—Does drug use during pregnancy constitute child abuse?—is unpleasant to contemplate, but it is one of absolute importance.

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Doctors and Medical Professionals in Round Table Discussion

Aspiring Doctors Seek Advanced Training In Addiction Medicine

The U.S. surgeon general’s office estimates that more than 20 million people have a substance-use disorder. Meanwhile, the nation’s drug overdose crisis shows no sign of slowing.

Yet, by all accounts, there aren’t nearly enough physicians who specialize in treating addiction — doctors with extensive clinical training who are board certified in addiction medicine.

The opioid epidemic has made this doctor deficit painfully apparent. And it’s spurring medical institutions across the United States to create fellowships for aspiring doctors who want to treat substance-use disorders with the same precision and science as other diseases.

Now numbering more than 60, these fellowship programs offer physicians a year or two of postgraduate training in clinics and hospitals where they learn evidence-based approaches for treating addiction.

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Many recovering from addiction have chronic health problems, diminished quality of life

Alcohol and other substance-use problems take enormous psychological and societal tolls on millions of Americans. Now a study from the Massachusetts General Hospital (MGH) Recovery Research Institute shows that more than a third of individuals who consider themselves in recovery from an alcohol or other substance use disorder continue to suffer from chronic physical disease. The study, published online March 20 in the Journal of Addiction Medicine, is the first to look at the national prevalence of medical conditions that are commonly caused or exacerbated by excessive and chronic alcohol and other drug use among people in addiction recovery.

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