Scientists Explore Deep Brain Stimulation (DBS) to Fight Addiction

doctors doing brain surgery

Addiction is costly in many ways. It can cost relationships, families, jobs, and lives. The stigma of addiction can cause people not to seek help, and it seems that the stigma is international, just like the disease of addiction itself.

China has been experimenting with different solutions for addiction for years. People often go to the research doctors out of desperation. A recent article by the Associated Press detailed the desperation a man named Yan, in China, felt when over the years he became addicted to crystal meth and, eventually, heroin. His father wanted to help but was tired of watching him bounce in and out of drug rehabilitation. He gave him a choice between another trip to drug rehabilitation, or to try Deep Brain Stimulation surgery. “Of course, I chose surgery,” Yan said. “With surgery, I definitely have the chance to get my life back.”

China’s Research into DBS for Addiction

China doesn’t have the same medical laws as America, and for many years they tried an archaic and painful surgery to “cure” addiction doctors call “brain lesioning”.  Desperate families paid doctors thousands of doctors to “lesion” the brain. Similar to a lobotomy, the method destroyed small clumps of brain tissue, causing a variety of neurological ailments for patients, including mental health disorders, memory problems and sexual dysfunction. Even worse, it rarely worked.

Deep brain surgery involves an implant in the brain, which electrically stimulates specific areas. In the United States, DBS has only been approved for Parkinson’s disease. Few patients, however, can afford the $100,000 DBS surgery costs.  

In China, where medical regulations are lax, clinical trials are already underway. Dr. Sun Bomin, director of Ruijin Hospital’s functional neurosurgery department, says the need outweighs concerns about side effects or efficacy. “They are human beings. You cannot say, ‘Oh, we do not have any help, any treatment for you guys.’”

Sun said he has served as a consultant for two Chinese companies that make deep brain stimulators — SceneRay Corp. and Beijing PINS Medical Co. He has tried to turn Ruijin into a center of DBS research, not just for addiction, but also Tourette syndrome, depression and anorexia.

China’s studies don’t come to any definitive conclusions. One trial had a patient that died from a heroin overdose just a few months after surgery. Another study in January by doctors at a military hospital in Xi’an found five out of eight heroin users stayed off drugs for two years after DBS surgery.

Yan, it turns out, is more of a Guinea pig than a patient. There are risks of a brain hemorrhage, changes to his personality, seizures, or an infection. There is also scant evidence that DBS will cure or treat his addiction.

DBS in the USA

The scientific community has concerns about any clinical trials done in China, outside of labs with ethical guidelines and rigor in place.

“It would be fantastic if there were something where we could flip a switch, but it’s probably fanciful at this stage,” Adrian Carter, who heads the neuroscience and society group at Monash University in Melbourne, told the Associated Press “There’s a lot of risks that go with promoting that idea.”

Few clinical trials have explored DBS outside of Parkinson’s research. U.S. clinical trials on DBS for depression were nixed due to a lack of evidence for benefits. (It is incredibly hard for scientists to ethically justify cutting into somebody’s skull without any scientific evidence it will help.) SceneRay, another Chinese company exploring DBS for addiction, was turned down for clinical research trials by the U.S. Food and Drug Administration.

However, the FDA has allowed a small, separate trial of DBS for opioid use disorder. Led by Dr. Ali Rezai, at the West Virginia University Rockefeller Neuroscience Institute, it will launch in June.

Purdue Pharma is Exploring Bankruptcy

courtroom bankruptsy

Purdue Pharma, the manufacturer of Oxycontin, is exploring the idea of bankruptcy to protect itself from over a thousand lawsuits filed across the country blaming them, in part, for the opioid addiction crisis that has claimed thousands of lives in states across the US.

The manufacturer of Oxycontin, as well as the Sackler family that controls the majority of the company, say they are under duress due to the massive litigation they face by counties, cities, and states. They have been repeatedly accused of misleading doctors through marketing and sales pressures, without mentioning the risks of addiction or downplaying those risks entirely.

The bankruptcy type that Purdue is considering is Chapter 11, which would stop the lawsuits from moving forward as Purdue settles the trials under the direction of a bankruptcy judge. Purdue hired law firm Davis Polk & Wardwell LLP for restructuring advice last August, making litigants nervous about the possibility of an insolvency claim to shut down the lawsuits.

A thousand lawsuits have been consolidated through a federal court in Ohio, where Purdue has held preliminary discussions to resolve the litigation, but nothing has come of these discussions. The breadth of the of the lawsuits has often been compared to the tobacco lawsuits in the 1990s, which dragged on for years and eventually resulted in a 246 billion dollar settlement, the largest in US history.

When asked by Yahoo News to comment, Purdue issued the following statement:

“As a privately-held company, it has been Purdue Pharma’s longstanding policy not to comment on our financial or legal strategy,” Purdue said in a statement.

“We are, however, committed to ensuring that our business remains strong and sustainable. We have ample liquidity and remain committed to meeting our obligations to the patients who benefit from our medicines, our suppliers and other business partners.”

Prescription opioids such as Oxycontin and fentanyl, as well as heroin, caused about involved in 47,600 overdose deaths in 2017according to the latest data from the U.S. Centers for Disease Control. Hundreds of states, counties, and cities have launched lawsuits due to the public health crisis.

 

 

Border Patrol Nabs Largest Fentanyl Bust Ever

US Border Patrol

Last week, the federal government announced one of the largest fentanyl drug busts ever, containing 254 pounds of the synthetic drug.

The bust occurred at the Nogales, Arizona border onboard a truck that hid the pills under cucumbers. Alongside the powerful opioid, there was also 354 pounds of methamphetamine. Both drugs have been on the rise in America the past few years, with fentanyl deaths outpacing other opioid deaths rapidly. At its current pace, according to US Customs and Border Control, the opioid epidemic kills ninety people a day.

The fentanyl in the seizure is valued $3.5 million and is twice the size of a haul discovered in a truck stopped by state troopers in Nebraska in 2017.

Fentanyl is quickly becoming one of the deadliest opioids in the United States, and it often comes to the US via China, passing through US Customs undetected. Last year, the opioid task force recommended that Congress fund new machines for the United States Postal Service that detect drugs. The majority of international drug traffickers send shipments of pills through mail services, but drugs like methamphetamine typically come through the US/Mexico border.

Fentanyl is a drug that has been found not only in pill form but also powdered form, which could easily kill a non-opioid user exposed to it. Fentanyl is at least fifty times stronger than morphine, a highly potent narcotic. When handling drugs like these, police officers have to use gloves and sometimes have to cover their mouths and arms to decrease their risk of exposure. Most first responders in America now keep a steady supply of Narcan, an opioid antagonist, on hand to deal with accidental exposure or overdoses. The US Customs and Border Patrol even describes taking precautions for their K-9 units, who have long been at risk of overdose due to the nature of their jobs. (A drug-sniffing dog often sticks its snout near loose drug powder or pills.)

The US Border Patrol stops drug traffickers almost every day of the week. Drugs often come through regular checkpoints, and large amounts of drugs come through trucks and cars.

 

 

 

 

 

 

Cocaine-Opioid Cocktails Have Been Killing Since 2010

flaming candles

People have been dying from opioid and cocaine cocktails regularly since 2010, but there hasn’t been much reporting on it. That’s partially because the focus is on the fact that these deaths were from opioids. But calling these deaths “opioid overdoses” is problematic because, in some cases, the drug users were never aware that they were using an opioid.

According to the Washington Examiner, more than 10,100 people died from mixing the drugs in 2017. 7,241 of those deaths showed both cocaine and fentanyl in their systems. Fentanyl is a potent opioid about 50 to 200 times stronger than morphine. It’s also the deadliest opioid in the US, with the majority of deaths in 2017.

Deaths caused by opioids and cocaine have risen nearly 76 percent since 2012.

Recently, opioid test strips have emerged across the United States as a part of harm-reduction efforts. The strips, which cost $1 each and have been given out with needle exchange programs and at other places drug users frequent, can detect even a minute amount of fentanyl. Cocaine and heroin users must mix some the drug with water to create a liquid form.

The test strips are not perfect and sometimes may give a false positive. Officials worry that the strips will give drug users a sense of false security, but harm reduction proponents say that combined with other methods of harm reduction, such as t6he overdose-reversal drug Naloxone, it will save lives. People will use their drug of choice, either way, harm reduction advocates say.

Harm reduction advocates hope that these tools, combined, will give a person enough tools to stay alive so that when they want to quit getting high, they can. After all, you can’t get a dead person into addiction treatment.

It’s not clear why drug dealers are adding fentanyl to the supply of other illicit street drugs. Many of the drugs sold in the US come from chemists in China or other international supply. Sometimes the drugs are pressed in the US, but sometimes the drugs are bought already formulated.

Getting the drugs off the streets seems a monumental task. Testing for the drugs, however, will be a bit more straightforward now that the test strips have begun to circulate.

Grant Awarded to Create, Upgrade Much-Needed Sober Housing in Mass.

Image of a man's hand pointing at miniature models of ranch-style homes.

In Massachusetts, in some ways, they are catching up to the opioid epidemic and facing it head-on. This sometimes means sending addicted patients home with medication-assisted treatment, offering sober coaching programs, and even providing drop-in clinics in some cities where drug addiction therapy is scarce. Now, The Center for Community Recovery Innovations (CCRI) has awarded a total of $696,995 in grant funding to help house recovery populations that include men, women, families, veterans, the homeless and ex-offenders.

The money will go to creating and modernizing 118 affordable sober housing units in communities across Massachusetts.

The grants come from the Center for Community Recovery Innovations, Inc. (CCRI), a nonprofit subsidiary of MassHousing. The goal of the award is to help nonprofits create or preserve affordable sober housing in Massachusetts.

This is not the first grant that has been awarded to support substance-free housing. Total, CCRI has awarded more than $10 million in grants. Without these grants, there would be few options for recovery housing, which is often considered the best option for people who have completed a long-term residential program. Sober homes help formerly addicted people to transition back into the community slowly.

Total, CCRI has helped create and maintain nearly 2,200 units of substance-free housing. In Worcester, the Latin American Health Alliance was able to put a down payment on financing to acquire Casa Colon, which will create 11 units of affordable sober housing for men, an essential addition for the overlooked demographic of LatinX community members in recovery.

“A safe, healthy and supportive housing environment is a critical component to substance misuse recovery,” said MassHousing Executive Director Chrystal Kornegay. “These grants help to meet the tremendous need for sober housing that is affordable and accessible to individuals who are working to overcome addiction. The projects funded through these awards will strengthen communities across the Commonwealth, by creating and modernizing affordable homes that promote successful recovery, helping individuals in need access the critical support services they need to successfully prevail over substance misuse.”

 

Tainted Cocaine Causing Brain Damage

brain damage

A dangerous new substance that’s used as an anti-worming agent has been found in recent cocaine samples taken by Swiss researchers, according to a report by Big Think.

Cocaine is the second-most popular drug worldwide, and it’s almost always “cut” with another drug or substance so that the drug is more profitable. In some cases, medications like fentanyl are added to cocaine to make it more addictive – but it’s also more dangerous. Usually, it’s baking soda or ammonia that’s added with the simple goal of thinning out the drug content.

Now, however, two studies from the University of Zurich (UZH) discovered that levamisole, a powerful animal anti-worming agent, has been turning up in the cocaine supply. Scientists speculate that it is being used by chemists to make the effects of cocaine last longer.

It’s also possible that it’s leaving brain damage in regular cocaine users. The long-term effects are impaired cognitive performance and the thinning out the prefrontal cortex. Levamisole is also leading to changes in blood counts and blood vessels, and in animals, it has been shown to attack the nervous system.

Two Studies Show Damage From Levamisole

A team from the Psychiatric Hospital and the Institute of Forensic Medicine identified people who had ingested the levamisole-tainted cocaine through a hair drug test. The higher levamisole levels in their body, the more they exhibited impairment of cognitive functions.

A second study had users who took the drug with levamisole in it had MRI’s to view the effects of the drug on their brain. The MRI study showed that people who ingested the cocaine with a high level of levamisole had a very clear thinning of the prefrontal cortex. This finding is significant because it’s the part of the brain responsible for executive functions.

Where is the Brain Damage?

Executive function is the part of the brain that provides self-control, working memory, and mental flexibility. Most of these functions are needed when you are problem-solving, and without them, people make poor choices.

 

 

Horizon BCBC Offers NJ Members Free Peer Recovery Counselors

A blond woman is having a videochat. A computer sits on her lap and a man is on the computer, talking to her.

In New Jersey, Horizon Blue Cross Blue Shield is offering their clients a new secret weapon as they begin their recovery journey. Peer recovery counselors, trained to help others who are trying to get clean, will be offered to anyone who is currently receiving treatment for a substance use disorder.

The counselors will be available 24/7 via telehealth sessions. The sessions will take place over live video chat, which is how they can be offered any time, day or night. Horizon told the media that about 1.35 million of the 3 million members they currently have would be eligible for the program. Nearly seven out of a hundred thousand people in their network end up seeking help for a substance use disorder.

Why Peer Recovery Counselors?

Allen Karp, Horizon’s executive vice president, says that peer-support programs “dramatically improves a person’s chances of achieving long-term success.” People in treatment or counseling, who have begun treatment and are considered “stable” will be eligible for extra help.  The first few months are a critical point in many peoples’ recovery journey; when they begin to feel better and wonder if they need to stay in treatment at all. A recovery support specialist, who has been through similar things, can often reassure people that staying clean and sober is worth it.

About 1.35 million of the 3 million people insured by Horizon will be eligible for the program, a spokesman said. Horizon’s commercially insured members are diagnosed with substance disorder at a rate of slightly more than seven in 1,000.

This tactic of using healthcare to try to help people in recovery isn’t new, but it’s rare. Healthcare companies, including insurers, have been limited in their support of treatment centers. After all, there are high relapse and drop out rates. Horizon BCBS is trying to change that.

New Jersey seems to be leading the charge for healthcare-facilitated drug addiction treatment. Currently, the state of New Jersey also funds “opioid recovery specialists” – people who visit patients who just experienced an overdose. In recovery themselves, they’re there to let overdose victims know that there’s a better way of life. Their purpose is to engage the patient and encourage them to get treatment.

How Will the Opioids Crisis Response Act Fight Addiction?

Opioids Crisis Response Act into law

Much to the excitement of addiction recovery advocates and after a time stalled in Congress, lawmakers are finally close to passing a hefty bill to combat opioid abuse. The measure would combine law enforcement and public health measures, and includes initiatives and funding to help make addiction recovery services more accessible to people with opioid use disorder. If passed, the law will be the most comprehensive action to date to deal with the opioid epidemic.

The bill is a rare bipartisan effort in a time where many initiatives have stalled entirely due to the deep political divides in both the House and the Senate. The bill itself stalled in the House of Representatives earlier because Democrats objected to a part of the law that would benefit a group tied to the pharmaceutical industry that helped create the epidemic of addiction that our country faces today.

Finally, a compromise was reached in the Senate this week removing the provision, and the bill was modified to focus on a variety of other efforts, including:

  • Attacking illegally imported drugs by creating a new type of cooperation between the federal Food and Drug Administration and Customs and Border Protection.
  • Providing the Postal Service with tools and equipment to detect and stop illegal shipments of synthetic compounds like fentanyl from coming into the country.
  • Providing money to increase boost research on non-opioid pain treatments
  • Make substance-abuse therapy more accessible to Medicare via telemedicine services.
  • Create a pilot program of Medicare coverage for opioid addiction treatment.
  • Give more access to medication-assisted treatment by lifting a cap on the number of patients (from 100 to 275) that a qualified doctor can prescribe drugs like Suboxone, a drug that helps limit opioid cravings and ease the physical pain of withdrawal.
  • Authorize $500 million per year through 2021 for new grants to help states fight opioid addiction.
  • Create new grants to be used by the Department of Health and Human Services to develop to help support addicts in recovery in their transition to independent living. It would also help create job programs for them.
  • Launch a pilot program that would provide temporary sober housing for people in recovery.

Although addiction recovery advocates say that the bill still doesn’t provide the states with enough money, it’s a good step towards combating the opioid addiction epidemic. Some of the funds may be matched in the states to help round out the costs.

The Senate expects to vote on the legislation next week.

 

 

 

 

Single-Step Naloxone Most Effective in Reversing Overdoses

Naloxone Narcan

Addiction professionals and first responders cope with a lot of variables when responding to an overdose, but nothing has changed the outcomes of emergency calls like Naloxone (also known as Narcan), an opioid antagonist drug that has the power to reverse overdoses. There are several versions of Naloxone delivery available. However, research has revealed that the single-step nasal inhaler seems to be most effective at reversing overdoses, according to new research led by faculty at Binghamton University, State University at New York.

In the past few years, expanded access to naloxone has saved thousands of lives by reversing fatal overdoses in people with opioid use disorder. While many people who overdose are not ready for help yet, others identify the moment their overdose occurred as a pivotal point in their life that helped them choose to get into recovery. Law enforcement and other first responders carry the drug on them all the time, especially in places like Ohio where overdoses take place in parking lots and other public spaces.

There is more than one way to administer Naloxone. Injections can be difficult for the untrained person to deliver, but there is often help available for people who choose to carry the drug. Sometimes injections are required multiple times for serious overdoses, and the skill of the person injecting the drug may come into play when it comes to reversing the drug.

William Eggleston, the clinical assistant professor at the School of Pharmacy and Pharmaceutical Sciences at Binghamton University, wanted to know if everyday people can successfully administer naloxone after basic video training. His research found that for ordinary people who aren’t first responders, the single-step nasal spray was used most successfully with minimal problems.

Eggleston conducted a study to estimate and compare the rate of successful administration and the time to successful administration by community members for single-step nasal spray, multi-step atomized nasal spray, and intramuscular simulated naloxone.

For the study, and over the course of several days, 138 adults with no prior naloxone training were asked to watch a two-minute video teaching them how to administer the drug. For each type of administration, they were asked to the adminster the reversal drug on a dummy.

After the video training, participants were able to administer the single-step nasal spray naloxone with a higher rate of success than the other types. This information is important for community naloxone programs across the United States.

“With training, nasal sprays, in general, had a higher degree of success than the shot,” Eggleston said. “Even if it seemed to us it was a no-brainer that we should be using nasal sprays, we had no data before, so now we have some to support that.”

Many people don’t realize it, but Naloxone has also been used to help people who have overdosed on other drugs such as synthetic marijuana and benzodiazepines.

The cost of the single-step Narcan spray is about $140, making it more cost prohibitive than the injection, which is about $40.

Image courtesy and copyright Adapt Pharma.

Fentanyl-Cocaine Combo Causing Deaths in MD

Image shows an empty hospital bed.

In Maryland, the government has been doing its best to fight the addiction crisis, but they’re not yet winning: in 2017, the number of fatal overdoses increased 9%. Most of these overdoses (90%) were considered to be opioid-induced, with Fentanyl overdoses increased by 42 percent last year, rising from 1,119 in 2016 to 1,594. Fentanyl is a drug that is 50 times stronger than heroin and is typically used in a medical setting. When added to other street drugs, it can be deadly, especially if novice opioid users are taking the drug. In Maryland, they have discovered that a fentanyl-cocaine combination of drugs is causing deaths. Between 2015 and 2016, cocaine deaths doubled because of this lethal combination.

The Maryland Department of Health Secretary Rober R. Neall called the increase in fentanyl-related deaths “staggering.” Officials think that the overdose deaths of cocaine containing fentanyl were accidental; the user may have had no clue that the two drugs were combined. Over 71% of cocaine deaths in 2017 was due to the fatal combination.

These deaths did not seem to have anything in common other than they were accidental. State officials say that the increase in cocaine deaths took place across demographics, affecting all age groups and both genders almost equally.

Heroin overdose deaths have also been decreased in the last year. In 2016, they had amounted to 58% of overdose deaths in the state.

In 2017, the amount of drug fatalities hit an all-time high in Maryland, although the actual increase in drug deaths was just 9%. This number compares to a 66% increase from 2016 to 2017. So it’s possible that efforts to combat fatal overdoses are working. One way the state is helping prevent these overdoses is via Narcan, an opioid antagonist that can help reverse overdoses. They are available both to first responders as well as over-the-counter for residents that have taken the training online.

 

 

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