Category: Addiction

Categories : Addiction Pain ManagementTags :

New Study Challenges the Need for Some Post-surgical Opioids

On By ModernMedia

Doctors must carefully weigh the pain relief value of opioids for patients against their potential for misuse and inducing opioid addiction even in patients with no history of substance abuse. Now, a new study challenges current practice by showing the effectiveness of an approach that takes a middle way to giving opioids.

Some 16 million people around the world suffer from opioid use disorder, which can result from opioid administration from surgery and for chronic pain. Opioids are highly addictive, with tolerance reached in days and addiction can occur within a matter of weeks, so there is every incentive to minimise exposure of patients to these effective but potentially dangerous medications.

To investigate the effectiveness of minimising opioid use, a team from Michigan Medicine at the University of Michigan conducted a study with 620 patients who had surgery in hospitals across Michigan, had their anaesthetic usage tracked, and filled in surveys within one to three months following their surgeries. The patients were split equally into two groups.
The first group received pre-surgery counseling emphasising non-opioid pain treatment as their first option. Some patients in this group received small, “just in case” prescriptions, but a third of them didn’t receive any opioid prescription at all after surgery.

The patients in the other group received standard care, that is, receiving the usual amount of opioids prescribed after such operations. The prescriptions received in fact were larger than in the opioid sparing group. Most patients didn’t take all of the pills, which if left lying around could be used inappropriately.

Patients in the two groups had the same surgery: either gallbladder removal, full or partial thyroid removal or hernia repair. However, both groups reported equal levels of quality of life and satisfaction with care when followed-up. Most surprisingly, the opioid-sparing group reported less pain overall.

First author Maia Anderson, MD, a resident in the U-M Department of Surgery, said: “It’s so exciting to think about the potential for opioid sparing postoperative pathways to not only reduce the risk of opioids for our patients, but also to substantially decrease the risk of opioid diversion into our communities.”

Senior author Ryan Howard, MD, Surgical Resident, Michigan Medicine commented: “We know that opioids pose serious risks to patients after surgery. We can protect patients from those risks by reducing or eliminating opioids after surgery. But that idea always raises the concern that patients will have uncontrolled pain and feel miserable. This study suggests that’s not the case – patients who get small opioid prescriptions, or even no prescription, are just as satisfied with their recovery after surgery.”

Source: News-Medical.Net

Journal information: Anderson, M., et al. (2020) Patient-Reported Outcomes After Opioid-Sparing Surgery Compared With Standard of Care. JAMA Surgery. doi.org/10.1001/jamasurg.2020.5646.

Categories : Addiction Mental HealthTags :

Happier Memories in Teens Linked to Less Alcohol and Marijuana Use

On By ModernMedia

A study of teenage American students has found that happy childhood memories, along with a positive view of the present and outlook for the future are associated with reduced alcohol use, binge drinking and marijuana use. 

Researchers say that action is needed because COVID restrictions have left teenagers isolated and vulnerable. Quarantining results in anxiety, stress and feelings of loneliness in children and adolescents, and the closure of schools has also taken away mental health support systems which some teenagers may rely on.

John Mark Froiland of Purdue University said: “School often seems a source of stress and anxiety to students. This puts them at greater risk of not participating in lessons, getting lower grades and of substance misuse. Many teenagers also aren’t engaging with online learning during Covid or have lower engagement levels.

“But they’re more likely to be enthusiastic learners and not use drink and drugs if teachers take time to build more positive relationships with them. They can help students see that everything they’re learning is truly valuable. Parents have a role to play too.”

The study was based on questionnaires completed by 1961 student participants in San Francisco, of which 53% were female. The researchers examined how happy the students believed their childhood was, how happy they were currently and how optimistic they were about their futures.

In addition, they looked at alcohol and marijuana use over the past 30 days and binge use, as well as academic grades, behaviour during lessons and motivation.

Positive attitudes towards the past, present and future was associated with lower alcohol use, binge drinking and marijuana use, while the reverse was true for negative attitudes.

An optimistic outlook increased the likelihood that they would be motivated and focus on learning. Other findings included drinking being associated with marijuana use, and that girls had better behavioural engagement than boys.

Source: News-Medical.Net

Journal information: Froiland, J.M., et al. (2020) Positive and negative time attitudes, intrinsic motivation, behavioral engagement and substance use among urban adolescents. Addiction Research & Theory. doi.org/10.1080/16066359.2020.1857740.

Categories : AddictionTags :

Withdrawal Symptoms of Discontinuing Medical Cannabis

On By ModernMedia

A new study on the long terms effects of having used medical cannabis show that over half of people who used it experience withdrawal symptoms between use. And about one in ten experienced worsening alterations in sleep, mood, mental state, energy and appetite over two years.

Patients who use cannabis usually turn to it because of the failure of other pain medications, or to avoid the long-term risks of opioid use. However, the perception that it is “harmless” is incorrect, as it has cannabinoids that act on receptors in the brain, and from which the brain can experience withdrawal symptoms. This can even lead to cannabis use disorder.

Addiction psychologist Lara Coughlin, PhD, who led the analysis said, “Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time.”

After they had gone a significant time without cannabis, the 527 participants in the study were asked whether they had any one of 15 symptoms, ranging from irritability to nausea. Using an analytic method, they empirically grouped them into three groups ranging from mild or moderate symptoms to severe, with most of the symptoms. They then surveyed the patients again after one year and then again after two years. Those in the mild class showed the most stability in symptoms over time.

Younger participants were more likely to be in the severe group, and were more likely to have a worsening trajectory. Coughlin concluded that patients seeking cannabis use for pain need to discuss it with their health care providers, and seek psychosocial treatments such as cognitive behavioural therapy.

Source: Medical Express

Journal information: Coughlin, LN et al. Progression of cannabis withdrawal symptoms in people using medical cannabis for chronic pain. Addiction. 2021. DOI: 10.1111/add.15370

Categories : Addiction CancerTags :

Nearly a Fifth of Cancer Patients on Opioids Misuse Them

On By ModernMedia

A new report reveals that 19% of cancer patients receiving opioids are misusing them, referred to a nonmedical opioid use (NMOU) behaviour. 

Opioid addiction remains a persistent and serious problem in the United States, and is growing elsewhere in the world, with some 16 million individuals worldwide suffering from opioid misuse disorder.
The study,  led by Sriram Yennurajalingam, MD, MS, of MD Anderson Cancer Center in Houston, included 1554 patients at a supportive care clinic for a comprehensive cancer centre. Of those engaging in NMOU behaviour, the most common (29%) was an early request for a refill, followed by self-directed dose escalation (15%), co-using illicit or non-prescribed drugs (13%), and impaired daily function due to opioids (11%).

Independent risk factors that increased the risk of NMOU behaviour included being single or divorced, as well as pain levels, opioid risk screening score, and morphine equivalent daily dose.

In their recommendations, Yennurajalingam and co-authors wrote: “Based on these findings, a universal screening, setting limits on opioid use by limiting supply, more intense follow-up with an interdisciplinary team to provide optimal use of medications for pain and symptom management, and the provision of counseling and support to patients and their family members may help prevent the development of these NMOU behaviors.”

Source: MedPage Today

Journal information: Yennurajalingam S, et al. Frequency of and factors associated with nonmedical opioid use behavior among patients with cancer receiving opioids for cancer pain, JAMA Oncol 2020; DOI: 10.1001/jamaoncol.2020.6789.

Categories : AddictionTags :

Il-10 Found to be Involved in Alcoholism

On By ModernMedia

Researchers have discovered that the anti-inflammatory IL-10 plays a direct role in alcoholism. Neurological research into addiction and alcohol has focused on the amygdala, which plays a key role in drives, emotions and behaviours.

Alcoholism is a growing problem in need of effective treatment. Interleukin 10 (IL-10) is an immune protein that has strong anti-inflammatory properties and is known to protect the brain from inflammation resulting from disease or injury.

In the brains of mice which chronically used alcohol, the amount of IL-10 was lowered in the amygdala and did not correctly signal neurons, and so was partly responsible for alcohol consumption behaviours. This was despite the overall higher level of IL-10 throughout the brains of chronic alcohol using mice.

“We found that chronic alcohol exposure compromises brain immune cells, which are important for maintaining healthy neurons,” said first author of the study Reesha Patel, PhD. “The resulting damage fuels anxiety and alcohol drinking that may lead to alcohol use disorder.”

The researchers counteracted the decrease of IL-10 amounts and signalling in mice, and the mice’s excessive alcohol use declined, and a decrease in anxiety was also noted.

Marisa Roberto, PhD, a professor in Scripps Research’s Department of Molecular Medicine, led the research. She said, “We’ve shown that inflammatory immune responses in the brain are very much at play in the development and maintenance of alcohol use disorder. But perhaps more importantly, we provided a new framework for therapeutic intervention, pointing to anti-inflammatory mechanisms.”

Source: Medical Xpress