Chapter 8. General Principles of Sensory Processing, Touch, and Pain
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Katherine Hobson Placebos can't cure diseases, but research suggests that they seem to bring some people relief from subjective symptoms, such as pain, nausea, anxiety and fatigue. But there's a reason your doctor isn't giving you a sugar pill and telling you it's a new wonder drug. The thinking has been that you need to actually believe that you're taking a real drug in order to see any benefits. And a doctor intentionally deceiving a patient is an ethical no-no. So placebos have pretty much been tossed in the "garbage pail" of clinical practice, says Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center. In an attempt to make them more useful, he has been studying whether people might see a benefit from a placebo even if they knew it was a placebo, with no active ingredients. An earlier study found that so-called "open-label" or "honest" placebos improved symptoms among people with irritable bowel syndrome. And Kaptchuk and his colleagues found the same effect among people with garden-variety lower back pain, the most common kind of pain reported by American adults. The study included 83 people in Portugal, all of whom had back pain that wasn't caused by cancer, fractures, infections or other serious conditions. All the participants were told that the placebo was an inactive substance containing no medication. They were told that the body can automatically respond to placebos, that a positive attitude can help but isn't necessary and that it was important to take the pills twice a day for the full three weeks. © 2016 npr
Keyword: Pain & Touch
Link ID: 22800 - Posted: 10.28.2016
Ian Sample Science editor Experiments with a fake body part have revealed how the brain becomes confused during a party trick known as the rubber hand illusion. Researchers in Italy performed the trick on a group of volunteers to explore how the mind combines information from the senses to create a feeling of body ownership. Under the illusion, people feel that a rubber hand placed on the table before them is their own, a bizarre but convincing shift in perception that is accompanied by a sense of disowning their real hand. The scientists launched the study after noticing that some stroke patients in their care experienced similar sensations, at times becoming certain that a paralysed limb was not their own, and even claiming ownership over other people’s appendages. “It is a very strong belief,” said Francesca Garbarini at the University of Turin. “We know that the feeling of body ownership can be dramatically altered after brain damage.” For the study, healthy volunteers sat with their forearms resting on a table and their right hand hidden inside a box. A lifelike rubber hand was then placed in front of them and lined up with their right shoulder. A cloth covered the stump of the hand, but the fingers remained visible. To induce the illusion, one of the researchers stroked the middle finger of the participant’s real hand while simultaneously stroking the same finger on the rubber hand. © 2016 Guardian News and Media Limited
Keyword: Pain & Touch
Link ID: 22780 - Posted: 10.24.2016
Laura Sanders Pain is contagious, at least for mice. After encountering bedding where mice in pain had slept, other mice became more sensitive to pain themselves. The experiment, described online October 19 in Science Advances, shows that pain can move from one animal to another — no injury or illness required. The results “add to a growing body of research showing that animals communicate distress and are affected by the distress of others,” says neuroscientist Inbal Ben-Ami Bartal of the University of California, Berkeley. Neuroscientist Andrey Ryabinin and colleagues didn’t set out to study pain transfer. But the researchers noticed something curious during their experiments on mice who were undergoing alcohol withdrawal. Mice in the throes of withdrawal have a higher sensitivity to pokes on the foot. And surprisingly, so did these mice’s perfectly healthy cagemates. “We realized that there was some transfer of information about pain” from injured mouse to bystander, says Ryabinin, of Oregon Health & Sciences University in Portland. When mice suffered from alcohol withdrawal, morphine withdrawal or an inflaming injection, they become more sensitive to a poke in the paw with a thin fiber — a touchy reaction that signals a decreased pain tolerance. Mice that had been housed in the same cage with the mice in pain also grew more sensitive to the poke, Ryabinin and colleagues found. These bystander mice showed other signs of heightened pain sensitivity, such as quickly pulling their tails out of hot water and licking a paw after an irritating shot. |© Society for Science & the Public 2000 - 20
Hannah Devlin Science correspondent Migraine sufferers have a different mix of gut bacteria that could make them more sensitive to certain foods, scientists have found. The study offers a potential explanation for why some people are more susceptible to debilitating headaches and why some foods appear to act as triggers for migraines. The research showed that migraine sufferers had higher levels of bacteria that are known to be involved in processing nitrates, which are typically found in processed meats, leafy vegetables and some wines. The latest findings raise the possibility that migraines could be triggered when nitrates in food are broken down more efficiently, causing vessels in the brain and scalp to dilate. Antonio Gonzalez, a programmer analyst at the University of California San Diego and the study’s first author, said: “There is this idea out there that certain foods trigger migraines - chocolate, wine and especially foods containing nitrates. We thought that perhaps there are connections between what people are eating, their microbiomes and their experiences with migraines.” When nitrates in food are broken down by bacteria in the mouth and gut they are eventually converted into nitric oxide in the blood stream, a chemical that dilates blood vessels and can aid cardiovascular health by boosting circulation. © 2016 Guardian News and Media Limited
Linda Geddes For the first time, a paralysed man has gained a limited sense of touch, thanks to an electric implant that stimulates his brain and allows him to feel pressure-like sensations in the fingers of a robotic arm. The advance raises the possibility of restoring limited sensation to various areas of the body, as well as giving people with spinal-cord injuries better control over prosthetic limbs. But restoring human-like feeling, such as sensations of heat or pain, will prove more challenging, the researchers say. Nathan Copeland had not been able to feel or move his legs and lower arms since a car accident snapped his neck and injured his spinal cord when he was 18. Now, some 12 years later, he can feel when a robotic arm has its fingers touched, because sensors on the fingers are linked to an implant in his brain. Brain implant restores paralysed man's sense of touch Rob Gaunt, a biomedical engineer at the University of Pittsburgh, performs a sensory test on a blindfolded Nathan Copeland. Nathan, who is paralysed, demonstrates his ability to feel by correctly identifying different fingers through a mind-controlled robotic arm. Video credit: UPMC/Pitt Health Sciences. “He says the sensations feel like they’re coming from his own hand,” says Robert Gaunt, a biomedical engineer at the University of Pittsburgh who led the study. © 2016 Macmillan Publishers Limited
By Elizabeth Pennisi Although it has a face—and body—that only a mother could love, the naked mole rat has a lot to offer biomedical science. It lives 10 times longer than a mouse, almost never gets cancer, and doesn’t feel pain from injury and inflammation. Now, researchers say they’ve figured out how the rodents keep this pain away. “It’s an amazing result,” says Harold Zakon, an evolutionary neurobiologist at the University of Texas, Austin, who was not involved with the work. “This study points us to important areas … that might be targeted to reduce this type of pain.” Naked mole rats are just plain weird. They live almost totally underground in colonies structured like honey bee hives, with hundreds of workers servicing a single queen and her few consorts. To survive, they dig kilometers of tunnels in search of large underground tubers for food. It’s such a tough life that—to conserve energy—this member of the rodent family gave up regulating its temperature, and they are able to thrive in a low-oxygen, high–carbon dioxide environment that would suffocate or be very painful to humans. “They might as well be from another planet,” says Thomas Park, a neuroscientist at the University of Illinois, Chicago. Gary Lewin, a neuroscientist at the Max Delbrück Center for Molecular Medicine in the Helmholtz Association in Berlin, began working with naked mole rats because a friend in Chicago was finding that the rodent's pain fibers were not the same as other mammals'. In 2008, the studies led to the finding that naked mole rats didn’t feel pain when they came into contact with acid and didn’t get more sensitive to heat or touch when injured, like we and other mammals do. Lewin was hooked and has been raising the rodents in his lab ever since. They are a little more challenging than rats or mice, he notes, because with just one female per colony producing young, he never really has quite enough individuals for his studies. © 2016 American Association for the Advancement of Science
Emma Yasinski Two often-overlooked medications might help millions of Americans who abuse alcohol to quit drinking or cut back. Public health officials, building on a push to treat people who abuse opioids with medications, want physicians to consider using medications to treat alcohol addiction. The drugs can be used in addition to or sometimes in place of peer-support programs, they say. "We want people to understand we think AA is wonderful, but there are other options," says George Koob, director of the National Institute of Alcohol Abuse and Alcoholism, a part of the federal National Institutes of Health. It is still rare for a person struggling with alcohol to hear that medication therapy exists. This partly reflects the tradition of treating addiction through 12-step programs. It's also a byproduct of limited promotion by the drugs' manufacturers and confusion among doctors about how to use them. A key study funded by the federal government reported last year that only 20 percent people who abuse alcohol will ever receive any form of treatment, which ranges from seeing a counselor or doctor to entering a specialized treatment program. The same is true for opioid addiction — about 80 percent of people dependent on opioids will never receive treatment. © 2016 npr
Keyword: Drug Abuse
Link ID: 22698 - Posted: 09.27.2016
James Gorman When the leader of a flock goes the wrong way, what will the flock do? With human beings, nobody can be sure. But with homing pigeons, the answer is that they find their way home anyway. Either the lead pigeon recognizes that it has no clue and falls back into the flock, letting birds that know where they are going take over, or the flock collectively decides that the direction that it is taking just doesn’t feel right, and it doesn’t follow. Several European scientists report these findings in a stirring report in Biology Letters titled, “Misinformed Leaders Lose Influence Over Pigeon Flocks.” Isobel Watts, a doctoral student in zoology at Oxford, conducted the study with her advisers, Theresa Burt de Perera and Dora Biro, and with the participation of Mate Nagy, a statistical physicist from Hungary, who is affiliated with several institutions, including Oxford and the Hungarian Academy of Sciences. Dr. Biro, who studies social behavior in primates as well as pigeons, said that the common questions that ran through her work were “about group living and what types of challenges and opportunities it brings.” She and her colleagues at Oxford have pioneered a method of studying flock behavior that uses very-fine-resolution GPS units, which the birds wear in pigeon-size backpacks. The devices record a detailed position for each bird a number of times a second. Researchers in Budapest and Oxford developed software to analyze small movements and responses of every bird in a flock. With this method, the scientists can identify which pigeons are leading the way. They can build a picture of how each bird responds to changes in the flight of other birds. © 2016 The New York Times Company
By Alison F. Takemura Bodies like to keep their pH close to 7.4, whether that means hyperventilating to make the blood alkaline, or burning energy, shifting to anaerobic metabolism, and producing lactate to make the blood acidic. The lungs and kidneys can regulate pH changes systemically, but they may not act quickly on a local scale. Because even small pH changes can dramatically affect the nervous system, a study led by Sten Grillner of Karolinska Institute in Sweden looked for a mechanism for pH homeostasis in the spinal cord. Using the lamprey as a model system, the researchers observed that a type of spinal canal neuron, called CSF-c, fired more rapidly when they bathed it with high pH (7.7) or low pH (7.1) media. They could suspend the elevated activity by blocking two ion channels: PKD2L1 channels, which stimulate neurons in alkaline conditions, or ASIC3 channels, which, the team showed previously, do the same in acidic states. As the neurons fired, they released the hormone somatostatin, which inhibited the lamprey’s locomotor network. These results suggest that, whichever direction pH deviates, “the response of the system is just to reduce activity as much as possible,” Grillner says. The pH-regulating role of CSF-c neurons is likely conserved among animals, the authors suspect, given the presence of these neurons across vertebrate taxa. © 1986-2016 The Scientist
Keyword: Movement Disorders
Link ID: 22688 - Posted: 09.24.2016
By Michael Price A soft brush that feels like prickly thorns. A vibrating tuning fork that produces no vibration. Not being able to tell which direction body joints are moving without looking at them. Those are some of the bizarre sensations reported by a 9-year-old girl and 19-year-old woman in a new study. The duo, researchers say, shares an extremely rare genetic mutation that may shed light on a so-called “sixth sense” in humans: proprioception, or the body’s awareness of where it is in space. The new work may even explain why some of us are klutzier than others. The patients’ affliction doesn’t have a name. It was discovered by one of the study’s lead authors, pediatric neurologist Carsten Bönnemann at the National Institutes of Health (NIH) in Bethesda, Maryland, who specializes in diagnosing unknown genetic illnesses in young people. He noticed that the girl and the woman shared a suite of physical symptoms, including hips, fingers, and feet that bent at unusual angles. They also had scoliosis, an unusual curvature of the spine. And, significantly, they had difficulty walking, showed an extreme lack of coordination, and couldn’t physically feel objects against their skin. Bönnemann screened their genomes and looked for mutations that they might have in common. One in particular stood out: a catastrophic mutation in PIEZO2, a gene that has been linked to the body’s sense of touch and its ability to perform coordinated movements. At about the same time, in a “very lucky accident,” Bönnemann attended a lecture by Alexander Chesler, a neurologist also at NIH, on PIEZO2. Bönnemann invited Chesler to help study his newly identified patients. © 2016 American Association for the Advancement of Science.
Nicola Davis Tyrannosaur, Breaking the Waves and Schindler’s List might make you reach for the tissues, but psychologists say they have found a reason why traumatic films are so appealing. Researchers at Oxford University say that watching traumatic films boosts feelings of group bonding, as well as increasing pain tolerance by upping levels of feel-good, pain-killing chemicals produced in the brain. “The argument here is that actually, maybe the emotional wringing you get from tragedy triggers the endorphin system,” said Robin Dunbar, a co-author of the study and professor of evolutionary psychology at the University of Oxford. Previous research has found that laughing together, dancing together and working in a team can increase social bonding and heighten pain tolerance through an endorphin boost. “All of those things, including singing and dancing and jogging and laughter, all produce an endorphin kick for the same reason - they are putting the musculature of the body under stress,” said Dunbar. Being harrowed, he adds, could have a similar effect. “It has turned out that the same areas in the brain that deal with physical pain also handle psychological pain,” said Dunbar. Writing in the journal Royal Society Open Science, Dunbar and colleagues describe how they set out to unpick whether our love of storytelling, a device used to share knowledge and cultivate a sense of identity within a group, is underpinned by an endorphin-related bonding mechanism. © 2016 Guardian News and Media Limited
By JACK HEALY CINCINNATI — On the day he almost died, John Hatmaker bought a packet of Oreos and some ruby-red Swedish Fish at the corner store for his 5-year-old son. He was walking home when he spotted a man who used to sell him heroin. Mr. Hatmaker, 29, had overdosed seven times in the four years he had been addicted to pain pills and heroin. But he hoped he was past all that. He had planned to spend that Saturday afternoon, Aug. 27, showing his son the motorcycles and enjoying the music at a prayer rally for Hope Over Heroin in this region stricken by soaring rates of drug overdoses and opioid deaths. But first, he decided as he palmed a sample folded into a square of paper, he would snort this. As he crumpled to the sidewalk, Mr. Hatmaker became one of more than 200 people to overdose in the Cincinnati area in the past two weeks, leaving three people dead in what the officials here called an unprecedented spike. Similar increases in overdoses have rippled recently through Indiana, Kentucky and West Virginia, overwhelming ambulance crews and emergency rooms and stunning some antidrug advocates. Addiction specialists said the sharp increases in overdoses were a grim symptom of America’s heroin epidemic, and of the growing prevalence of powerful synthetic opiates like fentanyl. The synthetics are often mixed into batches of heroin, or sprinkled into mixtures of caffeine, antihistamines and other fillers. In Cincinnati, some medical and law enforcement officials said they believed the overdoses were largely caused by a synthetic drug called carfentanil, an animal tranquilizer used on livestock and elephants with no practical uses for humans. Fentanyl can be 50 times stronger than heroin, and carfentanil is as much as 100 times more potent than fentanyl. Experts said an amount smaller than a snowflake could kill a person. © 2016 The New York Times Company
By The Scientist Staff Growing up, we learn that there are five senses: sight, smell, touch, taste, and hearing. For the past five years, The Scientist has taken deep dives into each of those senses, explorations that revealed diverse mechanisms of perception and the impressive range of these senses in humans and diverse other animals. But as any biologist knows, there are more than just five senses, and it’s difficult to put a number on how many others there are. Humans’ vestibular sense, for example, detects gravity and balance through special organs in the bony labyrinth of the inner ear. Receptors in our muscles and joints inform our sense of body position. (See “Proprioception: The Sense Within.”) And around the animal kingdom, numerous other sense organs aid the perception of their worlds. The comb jelly’s single statocyst sits at the animal’s uppermost tip, under a transparent dome of fused cilia. A mass of cells called lithocytes, each containing a large, membrane-bound concretion of minerals, forms a statolith, which sits atop four columns called balancers, each made up of 150–200 sensory cilia. As the organism tilts, the statolith falls towards the Earth’s core, bending the balancers. Each balancer is linked to two rows of the ctenophore’s eight comb plates, from which extend hundreds of thousands of cilia that beat together as a unit to propel the animal. As the balancers bend, they adjust the frequency of ciliary beating in their associated comb plates. “They’re the pacemakers for the beating of the locomotor cilia,” says Sidney Tamm, a researcher at the Marine Biological Laboratory in Woods Hole, Massachusetts, who has detailed the structure and function of the ctenophore statocyst (Biol Bull, 227:7-18, 2014; Biol Bull, 229:173-84, 2015). © 1986-2016 The Scientist
Laura Sanders Scientists have identified the “refrigerator” nerve cells that hum along in the brains of mice and keep the body cool. These cells kick on to drastically cool mice’s bodies and may prevent high fevers, scientists report online August 25 in Science. The results “are totally new and very important,” says physiologist Andrej Romanovsky of the Barrow Neurological Institute in Phoenix. "The implications are far-reaching." By illuminating how bodies stay at the right temperature, the discovery may offer insights into the relationship between body temperature and metabolism. Scientists had good reasons to think that nerve cells controlling body temperature are tucked into the hypothalamus, a small patch of neural tissue in the middle of the brain. Temperature fluctuations in a part of the hypothalamus called the preoptic area prompt the body to get back to baseline by conserving or throwing off heat. But the actual identify of the heat sensors remained mysterious. The new study reveals the cells to be those that possess a protein called TRPM2. “Overall, this is a major discovery in the field of thermoregulation,” says Shaun Morrison of Oregon Health & Science University in Portland. Jan Siemens, a neurobiologist at the University of Heidelberg in Germany, and colleagues tested an array of molecules called TRP channels, proteins that sit on cell membranes and help sense a variety of stimuli, including painful tear gas and cool menthol. In tests of nerve cells in lab dishes, one candidate, the protein TRPM2, seemed to respond to heat. |© Society for Science & the Public 2000 - 201
Keyword: Pain & Touch
Link ID: 22605 - Posted: 08.27.2016
Neuroscience News Researchers have identified a brain mechanism that could be a drug target to help prevent tolerance and addiction to opioid pain medication, such as morphine, according to a study by Georgia State University and Emory University. The findings, published in the Nature journal Neuropsychopharmacology in August, show for the first time that morphine tolerance is due to an inflammatory response produced in the brain. This brain inflammation is caused by the release of cytokines, chemical messengers in the body that trigger an immune response, similar to a viral infection. Researchers’ results show blocking a particular cytokine eliminated morphine tolerance, and they were able to reduce the dose of morphine required to alleviate pain by half. “These results have important clinical implications for the treatment of pain and also addiction,” said Lori Eidson, lead author and a graduate student in the laboratory of Dr. Anne Murphy in the Neuroscience Institute of Georgia State. “Until now, the precise underlying mechanism for opioid tolerance and its prevention have remained unknown.” Over 67 percent of the United States population will experience chronic pain at some point in their lives. Morphine is the primary drug used to manage severe and chronic pain, with 3 to 4 percent of adults in the U.S. receiving long-term opioid therapy. However, tolerance to morphine, defined as a decrease in pain relief over time, significantly impedes treatment for about 60 percent of patients. Long-term treatment with opioids is associated with increased risk of abuse, dependence and fatal overdoses.
Laura Sanders For some people, fentanyl can be a life-saver, easing profound pain. But outside of a doctor’s office, the powerful opioid drug is also a covert killer. In the last several years, clandestine drugmakers have begun experimenting with this ingredient, baking it into drugs sold on the streets, most notably heroin. Fentanyl and closely related compounds have “literally invaded the entire heroin supply,” says medical toxicologist Lewis Nelson of New York University Langone Medical Center. Fentanyl is showing up in other drugs, too. In San Francisco’s Bay Area in March, high doses of fentanyl were laced into counterfeit versions of the pain pill Norco. In January, fentanyl was found in illegal pills sold as oxycodone in New Jersey. And in late 2015, fentanyl turned up in fake Xanax pills in California. This ubiquitous recipe-tinkering makes it impossible for users to know whether they’re about to take drugs mixed with fentanyl. And that uncertainty has proved deadly. Fentanyl-related deaths are rising sharply in multiple areas. National numbers are hard to come by, but in many regions around the United States, fentanyl-related fatalities have soared in recent years. Maryland is one of the hardest-hit states. From 2007 to 2012, the number of fentanyl-related deaths hovered around 30 per year. By 2015, that number had grown to 340. A similar rise is obvious in Connecticut, where in 2012, there were 14 fentanyl-related deaths. In 2015, that number was 188. |© Society for Science & the Public 2000 - 2016.
Angus Chen Once people realized that opioid drugs could cause addiction and deadly overdoses, they tried to use newer forms of opioids to treat the addiction to its parent. Morphine, about 10 times the strength of opium, was used to curb opium cravings in the early 19th century. Codeine, too, was touted as a nonaddictive drug for pain relief, as was heroin. Those attempts were doomed to failure because all opioid drugs interact with the brain in the same way. They dock to a specific neural receptor, the mu-opioid receptor, which controls the effects of pleasure, pain relief and need. Now scientists are trying to create opioid painkillers that give relief from pain without triggering the euphoria, dependence and life-threatening respiratory suppression that causes deadly overdoses. That wasn't thought possible until 2000, when a scientist named Laura Bohn found out something about a protein called beta-arrestin, which sticks to the opioid receptor when something like morphine activates it. When she gave morphine to mice that couldn't make beta-arrestin, they were still numb to pain, but a lot of the negative side effects of the drug were missing. They didn't build tolerance to the drug. At certain dosages, they had less withdrawal. Their breathing was more regular, and they weren't as constipated as normal mice on morphine. Before that experiment, scientists thought the mu-opioid receptor was a simple switch that flicked all the effects of opioids on or off together. Now it seems they could be untied. © 2016 npr
By ABBY GOODNOUGH TUSCALOOSA, Ala. — Roslyn Lewis was at work at a dollar store here in Tuscaloosa, pushing a heavy cart of dog food, when something popped in her back: an explosion of pain. At the emergency room the next day, doctors gave her Motrin and sent her home. Her employer paid for a nerve block that helped temporarily, numbing her lower back, but she could not afford more injections or physical therapy. A decade later, the pain radiates to her right knee and remains largely unaddressed, so deep and searing that on a recent day she sat stiffly on her couch, her curtains drawn, for hours. The experience of African-Americans, like Ms. Lewis, and other minorities illustrates a problem as persistent as it is complex: Minorities tend to receive less treatment for pain than whites, and suffer more disability as a result. While an epidemic of prescription opioid abuse has swept across the United States, African-Americans and Hispanics have been affected at much lower rates than whites. Researchers say minority patients use fewer opioids, and they offer a thicket of possible explanations, including a lack of insurance coverage and a greater reluctance among members of minority groups to take opioid painkillers even if they are prescribed. But the researchers have also found evidence of racial bias and stereotyping in recognizing and treating pain among minorities, particularly black patients. “We’ve done a good job documenting that these disparities exist,” said Salimah Meghani, a pain researcher at the University of Pennsylvania. “We have not done a good job doing something about them.” Dr. Meghani’s 2012 analysis of 20 years of published research found that blacks were 34 percent less likely than whites to be prescribed opioids for conditions such as backaches, abdominal pain and migraines, and 14 percent less likely to receive opioids for pain from traumatic injuries or surgery. © 2016 The New York Times Company
By KATHARINE Q. SEELYE PORTLAND, Me. — A woman in her 30s was sitting in a car in a parking lot here last month, shooting up heroin, when she overdosed. Even after the men she was with injected her with naloxone, the drug that reverses opioid overdoses, she remained unconscious. They called 911. Firefighters arrived and administered oxygen to improve her breathing, but her skin had grown gray and her lips had turned blue. As she lay on the asphalt, the paramedics slipped a needle into her arm and injected another dose of naloxone. In a moment, her eyes popped open. Her pupils were pinpricks. She was woozy and disoriented, but eventually got her bearings as paramedics put her on a stretcher and whisked her to a hospital. Every day across the country, hundreds, if not thousands, of people who overdose on opioids are being brought back to life with naloxone. Hailed as a miracle drug by many, it carries no health risk; it cannot be abused and, if given mistakenly to someone who has not overdosed on opioids, does no harm. More likely, it saves a life. As a virulent opioid epidemic continues to ravage the country, with 78 people in the United States dying of overdoses every day, naloxone’s use has increasingly moved out of medical settings, where it has been available since the 1970s, and into the homes and hands of the general public. But naloxone, also known by the brand name Narcan, has also had unintended consequences. Critics say that it gives drug users a safety net, allowing them to take more risks as they seek higher highs. Indeed, many users overdose more than once, some multiple times, and each time, naloxone brings them back. © 2016 The New York Times Company
By Maia Szalavitz When a family member, spouse or other loved one develops an opioid addiction — whether to pain relievers like Vicodin or to heroin — few people know what to do. Faced with someone who appears to be driving heedlessly into the abyss, families often fight, freeze or flee, unable to figure out how to help. Families are sometimes overwhelmed with conflicting advice about what should come next. Much of the advice given by treatment groups and programs ignores what the data says in a similar way that anti-vaccination or climate skeptic websites ignore science. The addictions field is neither adequately regulated nor effectively overseen. There are no federal standards for counseling practices or rehab programs. In many states, becoming an addiction counselor doesn’t require a high school degree or any standardized training. “There’s nothing professional about it, and it’s not evidence-based,” said Dr. Mark Willenbring, the former director of treatment research at the National Institute on Alcohol Abuse and Alcoholism, who now runs a clinic that treats addictions. Consequently, families are often given guidance that bears no resemblance to what the research evidence shows — and patients are commonly subjected to treatment that is known to do harm. People who are treated as experts firmly proclaim that they know what they are doing, but often turn out to base their care entirely on their own personal and clinical experience, not data. “Celebrity Rehab with Dr. Drew,” which many people see as an example of the best care available, for instance, used an approach that is not known to be effective for opioid addiction. More than 13 percent of its participants died after treatment,1 mainly of overdoses that could potentially have been prevented with evidence-based care. Unethical practices such as taking kickbacks for patient referrals are also rampant.