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Activating Parts of the Brain Could Help Alleviate Opioid-Related Social Isolation

One of the many painful and challenging aspects of the US opioid crisis is that people abusing opioids often isolate themselves from family and friends, making it difficult for loved ones to help people on a path towards recovery.

Researchers from Arizona State University have identified a region in the brain that may be responsible for opioid-related social isolation, and their work suggests that activating this region could at least partially revive the urge to socialize among opioid addicts.

The research team, led by M. Foster Olive, focused on a brain area called the insula, which has previously been shown to play a role in social, addictive, and empathy-related behaviors. To study its role, the team turned to rats, which like humans are social and enjoy interacting. The researchers paired male rats together and randomly assigned one of each pair to be trapped in a plastic tube in a cage. The other rat in the pair could easily release the trapped animal by pushing on a door. Once a day for three weeks, the rescuer rat had an opportunity to release his trapped cage-mate — and most chose to do so.

The researchers then infused the rescuer rats with a virus that targeted cells in the insula and delivered one of three specialized proteins: one stimulated the cells of the insula; one suppressed those cells’ activity; and one was inactive and served as a control. Then they allowed all groups to self-administer heroin because, like humans, rats can become addicted to opioids and will self-administer if given the opportunity.

Finally, the rescuer rats were given a choice between freeing their cage-mates or administering themselves a dose of heroin. Rats given the virus suppressing the activity of cells in the insula, and those in the control group, more often chose heroin over rescuing. But rats infused with the virus that activated the cells started to rescue their friends again; the rescuing behavior recovered by about 30 percent.

The results suggest that the insula plays a role in the antisocial effects of opioid addiction, and these findings may lead to clinical applications, perhaps an adjunct treatment for opioid addiction in humans.

“A good social network is critical for recovery,” says Olive. “If we can stimulate this area of the brain in humans, you might get people to find social interactions more rewarding again. It would be a way to help jump-start the recovery process. It’s not a cure, it’s just a crutch to help get back on track and give people a better shot a recovery.”

Original article here.

Source: American College of Neuropsychopharmacology

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Psychiatrists Can, Should Help Address the Opioid Epidemic

Psychiatrists and mental health professionals have a vital role to play in addressing the national opioid epidemic, according to a viewpoint published in JAMA Psychiatry.

“We believe psychiatrists are uniquely skilled and ideally suited to be leaders in treating this epidemic,” Srinivas B. Muvvala, MD, from Yale School of Medicine, and colleagues wrote.

“Psychiatrists are unique among physicians in having specialty training in treating trauma, depression, and other co-occurring psychiatric disorders and assessing suicidal behavior; increasingly, there is a growing awareness of the association between suicide and opioid use,” they continued. “Psychiatrists can provide integrated mental health care and relapse prevention counseling and therefore are uniquely qualified to provide office-based addiction treatments efficiently.”

In this viewpoint, Muvvala and colleagues argued that all psychiatrists should have training in assessing and treating patients with opioid use disorder. To respond to the epidemic, they recommended more psychiatrists complete the 8-hour training needed to prescribe buprenorphine, psychiatrists include buprenorphine treatment in routine psychiatric practice, and all residency programs require buprenorphine education for physicians in training.

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Psychiatrists can incorporate buprenorphine treatment into outpatient practices easily and safely and recent evidence supports the safety and feasibility of physicians initiating buprenorphine treatment at home, according to the viewpoint. Mentoring programs are available to help physicians overcome any concerns when prescribing buprenorphine.

“Psychiatrists are in an excellent position to meet the requirement that buprenorphine be given in conjunction with psychosocial services,” Muvvala and colleagues wrote. “Psychiatrists can provide in-house counseling and also work collaboratively with other disciplines (eg, psychologists, social workers, nurses and counselors).”

In addition, Muvvala and colleagues wrote that U.S. general psychiatry residency programs are lacking in basic areas of training and only require 1 month of addiction treatment experience.

“Training programs need to broaden the exposure of residents to effective treatments in addiction, particularly in outpatient settings that include competency in prescribing medications for [opioid use disorder],” they wrote. “Buprenorphine training should be a required competency of psychiatry training.”

Ensuring that mental health clinicians know resources for training and mentoring psychiatrists to prescribe buprenorphine exist is critical, the authors wrote.

“Addressing the national opioid epidemic is the responsibility of every psychiatrist,” Muvvala and colleagues wrote. “With commitment and a modest investment in further training, the expertise of psychiatrists in treating other psychiatric disorders can be extended to the effective treatment of [opioid use disorder].” – by Savannah Demko

Disclosure: One author reports consulting for Alkermes; no other relevant financial disclosures were reported.

Muvvala SB, et al. JAMA Psychiatry. 2018;doi:10.1001/jamapsychiatry.2018.3123.

Original article here on Healio.com.

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