Chapter 4. The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
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By KATHARINE Q. SEELYE LAWRENCE, Mass. — When Eddie Frasca was shooting up heroin, he occasionally sought out its more potent, lethal cousin, fentanyl. “It was like playing Russian roulette, but I didn’t care,” said Mr. Frasca, 30, a carpenter and barber who said he had been clean for four months. When he heard that someone had overdosed or even died from fentanyl, he would hunt down that batch. “I’d say to myself, ‘I’m going to spend the least amount of money and get the best kind of high I can,’ ” he said. Fentanyl, which looks like heroin, is a powerful synthetic painkiller that has been laced into heroin but is increasingly being sold by itself — often without the user’s knowledge. It is up to 50 times more powerful than heroin and up to 100 times more potent than morphine. A tiny bit can be fatal. In some areas in New England, fentanyl is now killing more people than heroin. In New Hampshire, fentanyl alone killed 158 people last year; heroin killed 32. (Fentanyl was a factor in an additional 120 deaths; heroin contributed to an additional 56.) “It sort of snuck up on us,” said Detective Capt. Robert P. Pistone of the Haverhill Police Department in Massachusetts. He said that a jump in deaths in 2014 appeared to be caused by heroin, but that lab tests showed the culprit was fentanyl. Fentanyl represents the latest wave of a rolling drug epidemic that has been fueled by prescription painkillers, as addicts continue to seek higher highs and cheaper fixes. © 2016 The New York Times Company
Keyword: Drug Abuse
Link ID: 22032 - Posted: 03.26.2016
Angus Chen You've probably heard that a little booze a day is good for you. I've even said it at parties. "Look at the French," I've said gleefully over my own cup. "Wine all the time and they still live to be not a day younger than 82." I'm sorry to say we're probably wrong. The evidence that alcohol has any benefit on longevity or heart health is thin, says Dr. Timothy Naimi, a physician and epidemiologist at Boston Medical Center. He and his colleagues published an analysis 87 of the best research studies on alcohol's effect on death from any cause in the Journal of Studies on Alcohol and Drugs on Tuesday. "[Our] findings here cast a great deal of skepticism on this long, cherished belief that moderate drinking has a survival advantage," he says. In these studies, the participants get sorted into categories based on how much alcohol they think they drink. Researchers typically size up occasional, moderate and heavy drinkers against non-drinkers. When you do this, the moderates, one to three drinks a day, usually come out on top. They're less likely to die early from health problems like heart disease or cancer and injury. But then it gets very tricky, "because moderate drinkers tend to be very socially advantaged," Naimi says. Moderate drinkers tend to be healthier on average because they're well-educated and more affluent, not because they're drinking a bottle of wine a week on average. "[Their] alcohol consumption ends up looking good from a health perspective because they're already healthy to begin with." © 2016 npr
By Maryse Zeidler, CBC News Effective immediately, the overdose-reversing drug naloxone is available without a prescription in Canada. Health groups and advocates across the country have been clamouring for naloxone to be widely available in order to prevent deaths, following a flood of fatalities linked to street drugs containing the powerful opiate fentanyl. Health Canada issued a statement about the change on Tuesday following a brief consultation period that began in mid-January. The ministry said all 130 responses it received on the subject were in favour of the change. It said doctors, pharmacists and patient organizations were some of the groups included in the consultation. The most common comment, said Health Canada, was "the need for a more user-friendly dosage form." Currently the drug is administered through injection — it said a nasal-spray form isn't yet available in Canada. Other concerns included the need to train those administering the drug and the acknowledgement that making naloxone more widely available "is not the cure to the opioid abuse problem and we must not lose sight of the underlying causes of drug addiction."
Keyword: Drug Abuse
Link ID: 22018 - Posted: 03.23.2016
People who want to quit smoking are more likely to succeed if they go "cold turkey" by stopping abruptly, a study in Annals of Internal Medicine shows. Volunteers who used this approach were 25% more likely to remain abstinent half a year from the date that they give up than smokers who tried to gradually wean themselves off instead. The NHS says that picking a convenient date to quit is important. Make a promise, set a date and stick to it, it advises. And sticking to the "not a drag" rule can really help too. "Whenever you find yourself in difficulty say to yourself, 'I will not have even a single drag' and stick with this until the cravings pass," the service says. And it recommends seeing a GP to get professional support and advice to give up smoking. In the British Heart Foundation-funded study, nearly 700 UK volunteers were randomly assigned to one of two groups - a gradual quit group or an immediate quit group. All of the participants were also offered advice and support and access to nicotine patches and replacement therapy, like nicotine gum or mouth spray - services which are available for free on the NHS. After six months, 15.5% of the participants in the gradual-cessation group were abstinent compared with 22% in the abrupt-cessation group. Lead researcher Dr Nicola Lindson-Hawley, from Oxford University, said: "The difference in quit attempts seemed to arise because people struggled to cut down. It provided them with an extra thing to do, which may have put them off quitting altogether." Even though more people in the study said they preferred the idea of quitting gradually than abruptly, individuals were still more likely to stop for good in the abrupt group. © 2016 BBC.
Keyword: Drug Abuse
Link ID: 21993 - Posted: 03.16.2016
The CDC recommends non-opioid therapy, including exercise and over-the-counter pain medications, as the preferred treatment for chronic pain. It says opioids should only be prescribed — at the lowest effective dosage possible — when the benefits from pain reduction and bodily function outweigh the risks. In 2014, American doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to roughly 19,000 — the highest number on record. The number of Canadians who die every year from opioids is not readily known — the Canadian Centre on Substance Abuse does not track the statistics — but Toronto physician Nav Persaud told CBC News in 2014 that more than 1,000 Canadians die from painkillers every year. A 2012 study says one in eight deaths among young adults age 25 to 34 in Ontario and one out of every 170 deaths in the province as a whole are opioid overdoses. One in four people who entered a withdrawal management program at St. Joseph's Healthcare in Hamilton, Ont., were opioid patients in 2012, up from one in ten in 2002. Other studies have cast doubt on the effectiveness of opioids on chronic pain, raising questions on whether its limited long-term effects are worth the harmful risks. "The science is clear," CDC director Tom Frieden said Tuesday. "For the vast majority of patients, the known and often fatal risks [of opioids] far outweigh the proven and transient benefits." ©2016 CBC/Radio-Canada.
By ANDREW POLLACK An experimental drug derived from marijuana has succeeded in reducing epileptic seizures in its first major clinical trial, the product’s developer announced on Monday, a finding that could lend credence to the medical marijuana movement. The developer, GW Pharmaceuticals, said the drug, Epidiolex, achieved the main goal of the trial, reducing convulsive seizures when compared with a placebo in patients with Dravet syndrome, a rare form of epilepsy. GW shares more than doubled on Monday. If Epidiolex wins regulatory approval, it would be the first prescription drug in the United States that is extracted from marijuana. The drug is a liquid containing cannabidiol, a component of marijuana that does not make people high. As many as 30 percent of the nearly 500,000 American children with epilepsy are not sufficiently helped by existing drugs, according to GW. Parents of some of these children have been flocking to try marijuana extracts, prepared by medical marijuana dispensaries. A number of states, in response to pressure from these parents, have passed or considered legislation to make it easier to obtain marijuana-based products. And some families have become “marijuana refugees,” moving to Colorado where it has been easier to obtain a particular extract, known as Charlotte’s Web, after the girl who first used it to control seizures. Hundreds of other children and young adults have been using Epidiolex outside of clinical trials, under programs that allow desperate patients to use experimental drugs. While many parents have reported significant reductions in seizures, experts have been cautious about anecdotal reports, saying that such treatments needed to be compared with a placebo to make sure they work. As such, the results from the GW trial have been closely watched. © 2016 The New York Times Company
By KATHARINE Q. SEELYE CAMBRIDGE, Mass. — In Philadelphia last spring, a man riding a city bus at rush hour injected heroin into his hand, in full view of other passengers, including one who captured the scene on video. In Cincinnati, a woman died in January after she and her husband overdosed in their baby’s room at Cincinnati Children’s Hospital Medical Center. The husband was found unconscious with a gun in his pocket, a syringe in his arm and needles strewn around the sink. Here in Cambridge a few years ago, after several people overdosed in the bathrooms of a historic church, church officials reluctantly closed the bathrooms to the public. “We weren’t medically equipped or educated to handle overdoses, and we were desperately afraid we were going to have something happen that was way out of our reach,” said the Rev. Joseph O. Robinson, rector of the church, Christ Church Cambridge. With heroin cheap and widely available on city streets throughout the country, users are making their buys and shooting up as soon as they can, often in public places. Police officers are routinely finding drug users — unconscious or dead — in cars, in the bathrooms of fast-food restaurants, on mass transit and in parks, hospitals and libraries. The visibility of drug users may be partly attributed to the nature of the epidemic, which has grown largely out of dependence on legal opioid painkillers and has spread to white, urban, suburban and rural areas. © 2016 The New York Times Company
Keyword: Drug Abuse
Link ID: 21961 - Posted: 03.07.2016
By ANNA FELS THERE was something odd about my new patient. She was elegantly dressed and self-possessed, and yet she was slowly, rhythmically chewing gum, something I rarely see in my psychiatry sessions. Was she trying to cover up anxiety about this first encounter, I wondered, or was she perhaps hoping to project a kind of cool, laid-back style? We talked for a long time about why she had come to see me. Then, as is my practice with a new patient, I asked what, if any, psychiatric medications and nonprescription, psychoactive substances — legal or illegal — she had used. Her answer was a new one for me. She stated that she chewed approximately 40 pieces of nicotine gum per day and had done so for well over a decade. Responses to this question are often illuminating and can be rather humbling. Although doctors are trained to focus on prescription medications, there are and have always been nonprescription “remedies” for psychiatric conditions. And people’s preferences for one type of substance over another can give a glimpse into their symptoms and even their brain chemistry. If a patient tells me he falls asleep on cocaine, I wonder if he might have attention deficit disorder. A patient who smokes marijuana to calm down before important business meetings leads me in the direction of social phobia or other anxiety disorders. I often wonder if people who take ketamine recreationally might be depressed, since this anesthetic has been shown to have antidepressant effects and is, in fact, being investigated for potential therapeutic use. Sorting through patients’ uses of psychoactive substances, from cocaine to alcohol to coffee, leaves me with an appreciation of the wildly different neurochemistry of people’s brains. One person will drink alcohol and feel euphoric, witty and extroverted, and the next will be logy and nauseated. © 2016 The New York Times Company
Keyword: Drug Abuse
Link ID: 21960 - Posted: 03.07.2016
Angus Chen We know we should put the cigarettes away or make use of that gym membership, but in the moment, we just don't do it. There is a cluster of neurons in our brain critical for motivation, though. What if you could hack them to motivate yourself? These neurons are located in the middle of the brain, in a region called the ventral tegmental area. A paper published Thursday in the journal Neuron suggests that we can activate the region with a little bit of training. The researchers stuck 73 people into an fMRI, a scanner that can detect what part of the brain is most active, and focused on that area associated with motivation. When the researchers said "motivate yourself and make this part of your brain light up," people couldn't really do it. "They weren't that reliable when we said, 'Go! Get psyched. Turn on your VTA,' " says Dr. Alison Adcock, a psychiatrist at Duke and senior author on the paper. That changed when the participants were allowed to watch a neurofeedback meter that displayed activity in their ventral tegmental area. When activity ramps up, the participants see the meter heat up while they're in the fMRI tube. "Your whole mind is allowed to speak to a specific part of your brain in a way you never imagined before. Then you get feedback that helps you discover how to turn that part of the brain up or down," says John Gabrieli, a neuroscientist at the Massachusetts Institute of Technology who was not involved with the work. © 2016 npr
Link ID: 21954 - Posted: 03.05.2016
Ewan Birney The Daily Mail recently ran an article about how alcohol abuse could harm future generations, via the (exciting-sounding) mechanism of trans-generational epigenetics. This is an emotive topic, combining a commonplace habit (drinking beer and wine) with a scary outcome (harming your children, grandchildren and future generations) and adding a twist of science for gravitas. It’s not surprising that this research has been handed a megaphone by the mainstream press – but does the science stack up? To start with, the research was carried out in rats, as multi-generational experiments on humans are both grossly unethical and logistically extremely hard. This crucial bit of information is missing from both the Daily Mail headline and the paper’s title. Secondly, the big effects of alcohol consumption were mainly seen on the rats’ children and grandchildren – the effects on their great grandchildren were smaller. That is really important, because if there’s no effect on great grandchildren, it’s probably not due to epigenetics. Drinking large amounts of alcohol (for a rat) whilst pregnant would be expected to have an effect on the children and even the grandchildren. This is because the eggs of female mammals are made early on in foetal development, whilst a daughter is developing in the womb. So if that cell (the egg) also gives rise to a daughter, she will have directly experienced exposures that occurred during her maternal grandmother’s pregnancy. © 2016 Guardian News and Media Limited or its affiliated companies.
With the opioid epidemic reaching into every corner of the U.S., more people are talking about addiction as a chronic disease rather than a moral failing. For researcher A. Thomas McLellan, who has spent his entire career studying substance abuse, the shift is a welcome one, though it has come frustratingly late. McLellan is co-founder of the Treatment Research Institute in Philadelphia and former deputy director of the White House Office of National Drug Control Policy. His work has focused on understanding addiction as a disease and improving the ways it is treated, a mission that took a personal turn midway through his career when he lost a son to overdose. NPR's Audie Cornish spoke with McLellan about how addiction is viewed and how that view has shaped the treatment system we have today. He also has suggestions on how to make it better. On why addiction has traditionally been seen as a criminal justice issue, not a health issue Think about it. If you didn't have brain science, which has just really emerged in the last two or three decades, all you had to look at was the behavior of addicted people. They are not pleasant people when they are in full addiction. They steal, they lie, they swear they're going to do something and they don't. It's quite easy to think of this as it has been thought of for literally hundreds of years: as a character disorder, as poor upbringing as a problem of parenting. And that's how we approached it. It's not coincidence that the Justice Department has played such a pivotal role. The emerging science shows this is a brain disease. It's got the same genetic transmutability as a lot of chronic illnesses. And the organ that it affects is the brain, and within the brain it is motivation, inhibition, cognition, all those things that produce the aberrant, unpleasant behaviors that are associated with addiction. © 2016 npr
Keyword: Drug Abuse
Link ID: 21935 - Posted: 02.27.2016
By Roni Caryn Rabin Fatal prescription-drug overdoses in the United States have increased sharply in recent years. But while most of the deaths have involved opioid painkillers like oxycodone, a new study suggests that anti-anxiety medications now are playing an outsize role in overdose deaths. The number of Americans filling prescriptions for anti-anxiety drugs — benzodiazepines like Valium and Xanax that are used to treat anxiety, panic disorders and insomnia — increased 67 percent between 1996 and 2013, the study found. But the rate of overdose deaths involving these drugs increased more than fourfold. The analysis, published online last week in The American Journal of Public Health, found that 5.6 percent of American adults filled a benzodiazepine prescription in 2013, up from 4.1 percent in 1996. (The actual number of Americans filling a benzodiazepine prescription rose to 13.5 million in 2013, up from 8.1 million in 1996.) Meanwhile, the rate of overdose deaths involving anti-anxiety drugs reached 3.07 per 100,000 adults in 2013, up from 0.58 per 100,000 adults in 1996. With public attention focused primarily on opioid painkillers, the role of anti-anxiety drugs “fell under the radar,” said Dr. Marcus Bachhuber, the study’s author and an assistant professor of medicine at Montefiore Medical Center/Albert Einstein College of Medicine in the Bronx. Yet when benzodiazepines are abused or combined with other drugs or alcohol, they contribute to depressing the respiratory system, which can be deadly, he said. “If we’re going to address the prescription drug crisis, we can’t just focus on opioids,” he said. “We need to think more broadly about other drugs, like benzodiazepines.” © 2016 The New York Times Company
Keyword: Drug Abuse
Link ID: 21934 - Posted: 02.27.2016
By GABRIELLE GLASER On the rainy fall morning of their first appointment, Dr. Mark Willenbring, a psychiatrist, welcomed a young web designer into his spacious office with a firm handshake and motioned for him to sit. The slender 29-year-old patient, dressed in a plaid shirt, jeans and a baseball cap, slouched into his chair and began pouring out a story of woe stretching back a dozen years. Addicted to heroin, he had tried more than 20 traditional faith- and abstinence-based rehabilitation programs. In 2009, a brother died of an OxyContin overdose. Last summer, he attempted suicide by swallowing a fistful of Xanax. When he woke up to find he was still alive, he overdosed on heroin. At a boot camp for troubled teenagers, he said, staffers beat him and withheld food. After he refused to climb a mountain in a team-building exercise, they strapped him to a gurney and dragged him up themselves. The young man in the psychiatrist’s office paused, tears sliding down his cheeks. “Sounds like a prison camp,” Dr. Willenbring said softly, leaning forward in his chair to pass a box of tissues. He began explaining the neuroscience of alcohol and drug dependence, 60 percent of which, he said, is attributable to a person’s genetic makeup. Listening intently, the young patient seemed relieved at the idea that his previous failures in rehab might reflect more than a lack of will. Dr. Willenbring, 66, has repeated this talk hundreds of times. But while scientifically unassailable, it is not what patients usually hear at addiction treatment centers. © 2016 The New York Times Company
Keyword: Drug Abuse
Link ID: 21925 - Posted: 02.23.2016
Allison Aubrey It's no secret that stimulant medications such as Adderall that are prescribed to treat symptoms of ADHD are sometimes used as "study drugs" aimed at boosting cognitive performance. And emergency room visits linked to misuse of the drug are on the rise, according to a study published Tuesday in the Journal of Clinical Psychiatry. "Young adults in the 18- to 25-year age range are most likely to misuse these drugs," says Dr. Ramin Mojtabai, a professor at the Johns Hopkins Bloomberg School of Public Health and senior author of the study. A common scenario is this: A person who has been prescribed ADHD drugs gives or diverts pills to a friend or family member who may be looking for a mental boost, perhaps to cram for a final or prepare a report. And guess what? This is illegal. Overall, the study found that nonmedical use of Adderall and generic versions of the drug increased by 67 percent among adults between 2006 and 2011. The findings are based on data from the National Survey on Drug Use and Health. The number of emergency room visits involving Adderall misuse increased from 862 visits in 2006 to 1,489 in 2011 according to data from the Drug Abuse Warning Network . © 2016 npr
By SINDYA N. BHANOO The human brain is attracted to things that were once pleasing even if they no longer are, researchers report. Study participants were asked to find red and green objects on a computer screen filled with different colored objects. They received small rewards for finding the objects: $1.50 for the red ones and 25 cents for the green ones. The next day, while brain scans were conducted, participants were asked to find certain shapes on the screen. There was no reward, and color was irrelevant. Still, when a red object appeared, participants focused on it, and scans showed dopamine was released in their brains. “They are not getting a reward for that, yet part of the brain is saying, ‘Oh, there’s a reward — pay attention to it,’” said Susan M. Courtney, a cognitive neuroscientist at Johns Hopkins University and a co-author of the study in Current Biology. The findings may help researchers develop pharmaceutical treatments for problems like food or drug addiction. © 2016 The New York Times Company
Janet Raloff WASHINGTON ― Many people have turned to electronic cigarettes in hopes of avoiding the heart and cancer risks associated with smoking conventional tobacco products. But vaping appears far from benign, a trio of toxicologists reported February 11 and 12 at the American Association for the Advancement of Science annual meeting. If used as a means to totally wean people off of tobacco products, then e-cigarettes might have value, concedes Ilona Jaspers of the University of North Carolina at Chapel Hill. But she’s not sure. Unpublished data that she and the others presented at the meeting link e-cig products to a host of new risks. So vaping may not eliminate risks associated with conventional smoking, Jaspers maintains ― “and may actually be introducing new ones.” Her group examined scraped cells from the noses of otherwise healthy people who had a history of smoking, vaping or doing neither. The researchers then measured the activity levels in these cells of 594 genes associated with the body’s ability to fight infections. Among smokers, the activity of 53 genes was substantially diminished, compared with people who neither smoked nor vaped. Among vapers, those same 53 genes showed significantly diminished activity, Jaspers reported, as did 305 more. The normal role of these genes would suggest that the lung tissue as well as nasal tissue of smokers ― and especially vapers ―“may be more susceptible to any kind of infection.” © Society for Science & the Public 2000 - 2016.
Keyword: Drug Abuse
Link ID: 21889 - Posted: 02.13.2016
Could a painkiller turn people away from suicide? A preliminary trial of an opioid called buprenorphine shows that the drug can reduce suicidal thoughts after just one week. If validated in larger studies, it could become the first fast-acting anti-suicide drug. Such a drug is sorely needed. The US Centers for Disease Control and Prevention (CDC) estimates that more than 9 million adults in the country reported having suicidal thoughts in 2013. Over a million went on to attempt suicide. “Around 400,000 suicidal people are coming to emergency rooms every year,” says Elizabeth Ballard at the National Institute of Mental Health. “Pharmacologically, nothing has been approved for acute treatment of suicidal ideation so anything that can help them is greatly needed.” When people seek help, they may be offered behavioural therapy or drugs such as antidepressants. But neither of these is guaranteed to alleviate feelings, and both can take six weeks or more to kick in. Ketamine, a drug being considered as an immediate treatment, can cause hallucinations and its effects wear off quickly. “Having something you could use on your own outside of a hospital would be beneficial,” says Ballard. Jaak Panksepp at Washington State University and his colleagues decided to see whether an opioid can counter suicidal feelings. Opioids are one of the brain’s natural feel-good chemicals. They are released to relieve pain when we hurt ourselves, and are involved when we deal with mental pain, such as that caused by social rejection, a common trigger for suicidal thoughts. © Copyright Reed Business Information Ltd.
By Diana Kwon Antidepressants are some of the most commonly prescribed medications out there. More than one out of 10 Americans over age 12—roughly 11 percent—take these drugs, according to a 2011 report by the National Center for Health Statistics. And yet, recent reports have revealed that important data about the safety of these drugs—especially their risks for children and adolescents—has been withheld from the medical community and the public. In the latest and most comprehensive analysis, published last week in BMJ (the British Medical Journal),a group of researchers at the Nordic Cochrane Center in Copenhagen showed that pharmaceutical companies were not presenting the full extent of serious harm in clinical study reports, which are detailed documents sent to regulatory authorities such as the U.S. Food and Drug Administration and the European Medicines Agency (EMA) when applying for approval of a new drug. The researchers examined documents from 70 double-blind, placebo-controlled trials of two common types of antidepressants—selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI)—and found that the occurrence of suicidal thoughts and aggressive behavior doubled in children and adolescents who used these medications. This paper comes on the heels of disturbing charges about conflicts of interest in reports on antidepressant trials. Last September a study published in the Journal of Clinical Epidemiology revealed that a third of meta-analyses of antidepressant studies were written by pharma employees and that these were 22 times less likely than other meta-studies to include negative statements about the drug. © 2016 Scientific American
Link ID: 21860 - Posted: 02.04.2016
By Sara Solovitch It was November 2012 when Dennis Hartman, a Seattle business executive, managed to pull himself out of bed, force himself to shower for the first time in days and board a plane that would carry him across the country to a clinical trial at the National Institute of Mental Health (NIMH) in Bethesda. After a lifetime of profound depression, 25 years of therapy and cycling through 18 antidepressants and mood stabilizers, Hartman, then 46, had settled on a date and a plan to end it all. This clinical trial would be his last stab at salvation. For 40 minutes, he sat in a hospital room as an IV drip delivered ketamine through his system. Several more hours passed before it occurred to him that all his thoughts of suicide had evaporated. “My life will always be divided into the time before that first infusion and the time after,” Hartman says today. “That sense of suffering and pain draining away. I was bewildered by the absence of pain.” Ketamine, popularly known as the psychedelic club drug Special K, has been around since the early 1960s. It is a staple anesthetic in emergency rooms, regularly used for children when they come in with broken bones and dislocated shoulders. It’s an important tool in burn centers and veterinary medicine, as well as a notorious date-rape drug, known for its power to quickly numb and render someone immobile.
By Dwayne Godwin, Jorge Cham Drugs and other stimuli hijack dopamine signaling in the brain, causing changes that can lead to addiction © 2016 Scientific America
Keyword: Drug Abuse
Link ID: 21845 - Posted: 02.02.2016