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By Katharine Q. Seelye Fresh from completing his medical residency at Yale-New Haven Hospital in 1964, Dr. Herbert Kleber fulfilled his military obligation by volunteering for the United States Public Health Service. He expected to do research at the National Institutes of Health. But to his dismay he was assigned instead to the Public Health Service Prison Hospital at Lexington, Ky. This was the notorious “narcotics farm,” a centralized prison and drug treatment center where thousands of drug users were incarcerated at one time or another, including the actor Peter Lorre, the jazz trumpeter Chet Baker and the Beat writer William S. Burroughs, who described his experience there in his vivid novel “Junky” (1953). Dr. Kleber fulfilled his two-year obligation in place of being drafted and returned to Yale, intent on a career in psychiatry. But because he had worked at Lexington, people assumed he knew all about addiction. After all, Lexington’s Addiction Research Center was an incubator for advanced research (and was the forerunner for the National Institute on Drug Abuse). Patients, doctors and parents kept asking for his help. Finally, he gave in to what he decided was his destiny and, thanks to that unwanted detour to Lexington, went on to become one of the nation’s foremost experts in the field of drug addiction. Dr. Kleber died on Oct. 5 while vacationing in Greece with his wife, Anne Burlock Lawver, his son, Marc, and his daughter-in-law, Judith. Marc Kleber confirmed the death and said his father, who lived in Manhattan, died of a heart attack on the island of Santorini. He was 84. Dr. Kleber was a pioneer in researching the pathology of addiction and in developing treatments to help patients reduce the severe discomforts of withdrawal, avoid relapse and stay in recovery. When he began his work, in the 1970s, health care professionals were paying little attention to addiction. It was a blip in the medical school curriculum. © 2018 The New York Times Company

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25576 - Posted: 10.16.2018

Jake Harper Months in prison didn't rid Daryl of his addiction to opioids. "Before I left the parking lot of the prison, I was shooting up, getting high," he says. Daryl has used heroin and prescription painkillers for more than a decade. Almost four years ago he became one of more than 200 people who tested positive for HIV in a historic outbreak in Scott County, Ind. After that diagnosis, he says, he went on a bender. But about a year ago, Daryl had an experience that made him realize he might be able to stay away from heroin and opioids. For several days, he says, he couldn't find drugs. He spent that time in withdrawal. "It hurts all over. You puke, you get diarrhea," Daryl says. His friend offered him part of a strip of Suboxone, a brand-name version of the addiction medication buprenorphine that is combined with naloxone. Buprenorphine is a long-acting opioid that is generally used to treat opioid addiction. It reduces cravings for the stronger opioids he had been taking, prevents physical withdrawal from those drugs and comes with a significantly lower risk of fatal overdose. Daryl injected the buprenorphine, and his opioid withdrawal symptoms disappeared. (Daryl is his middle name, which NPR is using to protect his identity because it is illegal to use buprenorphine without a prescription.) "At first it felt like I was high," Daryl says. "But I think that's what normal feels like now. I have not been normal in a long time." © 2018 npr

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 8: General Principles of Sensory Processing, Touch, and Pain
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 5: The Sensorimotor System
Link ID: 25550 - Posted: 10.09.2018

By Neal Pollack AUSTIN, Tex. — My name is Neal, and I’m a marijuana addict. A year ago I wouldn’t have said that, because it would have meant giving up marijuana. I would rather have given up breathing. When I had my first cup of coffee in the morning, I pressed the little button on my vape pen, waited for the blue glow, took a huge inhale and then blew it into the mug so that I could suck in the THC and caffeine at the same time. Then I took another hit, and another. In the afternoons, I’d smoke a bowl, or pop a gummy bear, or both. At night, I got high before eating dinner or watching the ballgame. Maybe I’d stop getting stoned a little bit before bed, but what was the point? If I went to bed high, I could wake up high, too. What a time for people to get stoned! Marijuana has left the counterculture, exploded into the mainstream and transformed into a multibillion-dollar industry. Cannabis is now an essential part of any hip wellness and beauty regimen. Netflix offers a marijuana-themed cooking show. Cannabis should be legal. It has medical uses. Millions of people, most of them black and Latino men, have unjustly gone to jail for selling what should have been easily available in stores. States with the political courage to legalize it have seen their tax rolls bloom and have created thousands of jobs. Also, it’s delicious. But I’m not a child with intractable epilepsy, or a veteran with PTSD, or a person who just wants to chill a little, or Willie Nelson. Unless you count writing articles about marijuana, I’m not profiting from the industry. I’m just a middle-aged house dad with a substance-abuse problem. Like most pot addicts in denial, I spent years telling myself that marijuana isn’t addictive, and so I didn’t have a problem. But clearly I did. And I’m not the only one who suffers this way. © 2018 The New York Times Company

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25538 - Posted: 10.08.2018

By Jan Hoffman The Food and Drug Administration conducted a surprise inspection of the headquarters of the e-cigarette maker Juul Labs last Friday, carting away more than a thousand documents it said were related to the company’s sales and marketing practices. The move, announced on Tuesday, was seen as an attempt to ratchet up pressure on the company, which controls 72 percent of the e-cigarette market in the United States and whose products have become popular in high schools. The F.D.A. said it was particularly interested in whether Juul deliberately targeted minors as consumers. “The new and highly disturbing data we have on youth use demonstrates plainly that e-cigarettes are creating an epidemic of regular nicotine use among teens,” the F.D.A. said in a statement. “It is vital that we take action to understand and address the particular appeal of, and ease of access to, these products among kids.” F.D.A. officials described the surprise inspection as a follow-up to a request the agency made for Juul’s research and marketing data in April. Kevin Burns, Juul’s chief executive officer, said the company had already handed over more than 50,000 pages of internal documents to the F.D.A. in response to that request. “We want to be part of the solution in preventing underage use, and we believe it will take industry and regulators working together to restrict youth access,” he said. In recent months, the F.D.A. has increasingly expressed alarm over the prevalence of vaping among youths in high school and even middle school, which its commissioner, Dr. Scott Gottlieb, said had reached “epidemic proportions.” © 2018 The New York Times Company

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25521 - Posted: 10.03.2018

By Nora D. Volkow Although our society currently finds itself focused on the tragic epidemic of opioid overdoses, there remains no better example of the deadly power of addiction than nicotine. The measure of a drug’s addictiveness is not how much pleasure (or reward) it causes but how reinforcing it is—that is, how much it leads people to keep using it. Nicotine does not produce the kind of euphoria or impairment that many other drugs like opioids and marijuana do. People do not get high from smoking cigarettes or vaping. Yet nicotine’s powerful ability to reinforce its relatively mild rewards results in 480,000 deaths annually. There are probably several reasons why nicotine is so reinforcing, even if it is not as intensely rewarding as other drugs. Like other drugs, nicotine stimulates the release of dopamine in neurons that connect the nucleus accumbens with the prefrontal cortex, amygdala, hippocampus, and other brain regions; this dopamine signal “teaches” the brain to repeat the behavior of taking the drug. The amount of dopamine released with any given puff of a cigarette is not that great compared to other drugs, but the fact that the activity is repeated so often, and in conjunction with so many other activities, ties nicotine’s rewards strongly to many behaviors that we perform on a daily basis, enhancing the pleasure and the motivation that we get from them. Smokers’ brains have learned to smoke, and just like unlearning to ride a bike, it is incredibly hard to unlearn that simple, mildly rewarding behavior of lighting up a cigarette. © 2018 Scientific America

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25508 - Posted: 09.29.2018

By Carolyn Y. Johnson and Joel Achenbach The allegations of sexual assault against Judge Brett M. Kavanaugh have a common element of binge drinking, and highlight the powerful effects alcohol can have on adolescents and their still-developing brains. Alcohol not only changes behavior — sometimes with disastrous consequences — it can also interfere with memory formation, creating gaps that experts refer to as blackouts. “In the moment, the person can be functioning normally, with no sign there’s going to be memory impairment. But because those memories never get consolidated and stored, it’s like they never occurred, so you can’t recall them later on,” said Kate Carey, a clinical psychologist at Brown University School of Public Health. “Which doesn’t mean it didn’t happen.” Binge drinking and the imperfection of memory are likely to be discussed during Thursday’s hearing before the Senate Judiciary Committee. Christine Blasey Ford said the Supreme Court nominee became “stumbling drunk” and attacked her at a party in high school. Kavanaugh has denied the allegation. He also said in a television interview that he’d never had a blackout from alcohol. Binge drinking among U.S. high school students peaked in the early 1980s, when Kavanaugh was a student at Georgetown Prep. High school binge drinking has declined in recent decades in part because dozens of states, as well as the District of Columbia, raised the minimum legal drinking age to 21 in the 1980s, said Katherine Keyes, an epidemiologist at Columbia University and an expert on alcohol consumption.

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 17: Learning and Memory
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 13: Memory, Learning, and Development
Link ID: 25499 - Posted: 09.27.2018

By Bret Stetka More often than not a trip to Las Vegas is not a financially sound decision. And yet every year over 40 million people hand over their cash to the city’s many towering casinos, hoping the roulette ball rattles to a stop on black. Gambling and other forms of risk-taking appear to be hardwired into our psyche. Humans at least as far back as Mesopotamia have rolled the dice, laying their barley, bronze and silver on the line, often against miserable odds. According to gambling industry consulting company H2 Gambling Capital, Americans alone lose nearly $120 billion a year to games of chance. Now a set of neuroscience findings is closer than ever to figuring out why. Ongoing research is helping illuminate the biology of risky behaviors—studies that may one day lead to interventions for vices like compulsive gambling. The recent results show an explanation is more complex than looking at dysfunctional reward circuitry, the network of brain regions that fire in response to pleasing stimuli like sex and drugs. Risking loss on a slim chance of thrill or reward involves a complex dance of decision-making and emotion. A new study by a team from Johns Hopkins University appears to have identified a region of the brain that plays a critical role in risky decisions. Published September 20 in Current Biology, the authors analyzed the behavior of rhesus monkeys, who share similar brain structure and function to our own. And like us, they are risk-takers, too. © 2018 Scientific American

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 18: Attention and Higher Cognition
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 14: Attention and Consciousness
Link ID: 25481 - Posted: 09.22.2018

Nicola Davis Alcohol is responsible for more than 5% of all deaths worldwide, or around 3 million a year, new figures have revealed. The data, part of a report from the World Health Organization, shows that about 2.3 million of those deaths in 2016 were of men, and that almost 29% of all alcohol-caused deaths were down to injuries – including traffic accidents and suicide. The report, which comes out every four years, reveals the continued impact of alcohol on public health around the world, and highlights that the young bear the brunt: 13.5% of deaths among people in their 20s are linked to booze, with alcohol responsible for 7.2% of premature deaths overall. It also stresses that harm from drinking is greater among poorer consumers than wealthier ones. While the proportion of deaths worldwide that have been linked to alcohol has fallen to 5.3% since 2012, when the figure was at 5.9%, experts say the findings make for sobering reading. A WHO alcohol-control expert, Dr Vladimir Poznyak, who was involved in the report, said the health burden of alcohol was “unacceptably large”. “Unfortunately, the implementation of the most effective policy options is lagging behind the magnitude of the problems,” he said, adding that projections suggested both worldwide alcohol consumption and the related harms were set to rise in the coming years. © 2018 Guardian News and Media Limited

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25479 - Posted: 09.22.2018

Jon Hamilton Experiments with two gambling monkeys have revealed a small area in the brain that plays a big role in risky decisions. When researchers inactivated this region in the prefrontal cortex, the rhesus monkeys became less inclined to choose a long shot over a sure thing, the team reported Thursday in the journal Current Biology. "They did not like the gambles anymore," says Veit Stuphorn, an author of the study and an associate professor at Johns Hopkins University. The finding in our fellow primates adds to the evidence that human brains are capable of constantly adjusting our willingness to take risks, depending on factors such as what's at stake. "For a long time, people thought that this is like a personality trait, that some people are risk-takers and others are not," Stuphorn says. But recent research has shown that the same person who is very cautious about personal investments may be an avid bungee jumper. This study involved two monkeys that learned to play a computer game that gave them drops of juice when they won. The monkeys played voluntarily because they liked to gamble, Stuphorn says. The game offered two options. The first was a juice reward that was guaranteed, but usually small. The second was a gamble: It might bring a lot of juice, or none. The monkeys moved their eyes to indicate their choice in each round. © 2018 npr

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25477 - Posted: 09.21.2018

Aimee Cunningham Even as the country’s attention is focused on the ongoing opioid epidemic, a new study shows that the United States has had a wide-ranging drug overdose problem for decades, and it’s growing ever worse. Analyzing nearly 600,000 accidental drug poisoning deaths from 1979 to 2016 shows that the country has seen an exponential rise in these cases, with the number of deaths doubling approximately every nine years, researchers report in the Sept. 21 Science. More than 63,600 Americans died from all drug overdoses in 2016, according to the Centers for Disease Control and Prevention. Numbers of accidental overdose deaths due to individual drugs, such as heroin or methamphetamine, have varied during the 38-year time period. But combining the data, from the National Vital Statistics System, produces a clear — and troubling — pattern, one that portends that the overall overdose epidemic will continue in the future, the researchers conclude. “We need to focus on the entire epidemic,” not just a particular drug, to understand what’s driving the continued growth in drug overdose deaths, says coauthor Hawre Jalal, a health policy researcher at the University of Pittsburgh. Looking at mortality rates from all drugs together, a clear pattern emerges. This exponential growth curve (dotted line) suggests the overall drug overdose epidemic will continue to grow. |© Society for Science & the Public 2000 - 2018.

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25474 - Posted: 09.21.2018

By Ben Guarino If you give an octopus MDMA, it will get touchy and want to mingle. What sounds like the premise of a children’s book set at Burning Man is, in fact, the conclusion of a study published Thursday in the journal Current Biology. Neuroscientist Gül Dölen, who studies social behavior at the Johns Hopkins University School of Medicine, and octopus expert Eric Edsinger, a research fellow at Marine Biological Laboratory in Woods Hole, Mass., bathed octopuses in the psychedelic drug and observed the result. Most humans enjoy hanging with their buds. We share this trait with animals like dogs, but not with the California two-spot octopus. Octopus bimaculoides is an asocial creature, which means it avoids other octopuses whenever possible. Put it in a tank with another octopus, and it might become aggressive or squish itself shyly against a wall. There’s one exception — during mating, this asocial behavior stops. Dölen figured that a neuromechanism was at play and wondered whether MDMA (3-4-Methylenedioxymethamphetamine, better known as ecstasy) could trigger that mechanism to switch the cephalopod into a more social animal. This wasn’t wonder for its own sake. “There’s been a renaissance for looking at psychedelic drugs as possible therapeutics,” she said. Robert C. Malenka, a professor of psychiatry and neuroscience at Stanford University, who was not involved with this study, called for increased study of MDMA in an influential Cell paper in 2016. MDMA has taboo associations with psychedelia and rave culture — it’s classified as Schedule 1, reserved for illegal drugs with high abuse potential. Nevertheless, it is being explored as a therapy for military veterans with PTSD. © 1996-2018 The Washington Post

Related chapters from BN8e: Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 8: Hormones and Sex; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25473 - Posted: 09.21.2018

Ryan Kellman When a relationship ends but love remains, it can be both frustrating and embarrassing. Dessa, a well-known rapper, singer and writer from Minneapolis, knows the feeling well. She'd spent years trying to get over an ex-boyfriend, but she was still stuck on him. "You're not only suffering," she says, "You're just sort of ridiculous. Discipline and dedication are my strong suits — it really bothered me that, no matter how much effort I tried to expend in trying to solve this problem, I was stuck." But things changed when Dessa turned to the frontiers of neuroscience for help. She came across a TED Talk by Helen Fisher, a biological anthropologist and visiting research associate at Rutgers University. Using a type of brain scan called fMRI, Fisher had looked into the brains of lovestruck people and noticed that certain parts of their brains were unusually active. "That you could objectively measure and observe 'love' — that had never occurred to me before," Dessa says. She wondered: If science could map the sources of love in her brain, could it somehow make that love go away? The question led her to a controversial therapy technique called neurofeedback. The idea is simple: If you want to learn to lower your heart rate, it helps to be able to hear your pulse. And if you want to change patterns of brain activity, it might be helpful to be able to see what your brain is up to. © 2018 npr

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25465 - Posted: 09.18.2018

Ian Sample Science editor A radical gene therapy for drug addiction has been shown to dampen down cravings for cocaine and protect against overdoses of the substance that would normally be lethal. The therapy uses implants of stem cells which have been genetically engineered to release a powerful enzyme that removes the class A drug from the bloodstream. Tests in the lab showed that mice fitted with the implants lost their appetite for cocaine and survived massive overdoses of the drug that killed 100% of untreated animals. The work has raised hopes for a long term treatment for addiction that works by clearing drugs from the body as soon as they are injected, inhaled or ingested. The therapy would effectively make addicts immune to the substances. Lead researcher Ming Xu, a professor of anaesthesia and critical care at the University of Chicago, said the approach was “highly efficient and specific for eliminating cocaine.” “Compared to other gene therapies, our approach is minimally invasive, long term, low maintenance and affordable. It’s very promising,” he told the Guardian. Scientists have known for decades that an enzyme found in blood plasma called butyrylcholinesterase, or BChE, destroys cocaine by breaking it down into harmless byproducts. But the enzyme is not particularly fast-acting and does not linger in the bloodstream long enough to help those addicted to the drug. To create their new therapy, the Chicago researchers rewrote the DNA in mouse skin stem cells to make them churn out a modified form of BChE that is 4,400 times more potent than the natural enzyme. The scientists reasoned that clumps of these engineered cells, called organoids, could be implanted under the skin, where they would release the cocaine-busting enzyme into the blood. © 2018 Guardian News and Media Limited o

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25464 - Posted: 09.18.2018

Aimee Cunningham More than 2 million U.S. middle and high school students — or nearly 1 in 11 — have vaped marijuana, a new study suggests. Based on reports of teens’ e-cigarette use in 2016, researchers estimate that nearly 1 in 3 high school students, or roughly 1.7 million, have used pot in the devices. Nearly 1 in 4 middle school students, or 425,000, have done the same, the team reports online September 17 in JAMA Pediatrics. The numbers are the first nationwide estimates of teens’ and preteens’ use of marijuana in e-cigs, based on data from 20,675 sixth- to 12th-graders who participated in the 2016 National Youth Tobacco Survey. The most widely used tobacco products among U.S. youth, e-cigarettes are battery-powered devices that heat and vaporize liquids that usually contain nicotine (SN: 5/28/16, p. 4). But the devices can also vaporize dried marijuana leaves or buds as well as oils or waxes made from the plant’s primary active ingredient, tetrahydrocannabinol, or THC. The number of youth using marijuana in e-cigarettes isn’t surprising, says Bonnie Halpern-Felsher, a developmental psychologist at Stanford University School of Medicine who was not involved in the study. “It’s easy; it’s accessible; they can be stealthy in using it.” Vaping marijuana can be done more discretely than smoking a joint because there isn’t as much of the telltale odor, if any. And legalization of marijuana in some states has led to increased access to the drug, she says, and a change in social norms regarding the drug’s use. |© Society for Science & the Public 2000 - 2018.

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25463 - Posted: 09.18.2018

By Sheila Kaplan and Jan Hoffman WASHINGTON — The Food and Drug Administration on Wednesday declared that teenage use of electronic cigarettes has reached “an epidemic proportion,” and it put makers of the most popular devices on notice that they have just 60 days to prove they can keep their devices away from minors. The order was part of a sweeping government action that targeted both makers and sellers of e-cigarettes. If Juul Labs and four other major manufacturers fail to halt sales to minors, the agency said, it could remove their flavored products from the market. It also raised the possibility of civil or criminal charges if companies are allowing bulk sales through their websites. The agency said it was sending warning letters to 1,100 retailers — including 7-Eleven stores, Walgreens, Circle K convenience shops and Shell gas stations — and issued another 131 fines, ranging from $279 to $11,182, for selling e-cigarettes to minors. Federal law prohibits selling e-cigarettes to anyone under 18. In a briefing with reporters, the F.D.A. commissioner, Dr. Scott Gottlieb, said that more than two million middle and high school students were regular users of e-cigarettes last year. The government’s tactics underscore a dilemma in the public health community: In addressing one public health problem — cigarette smoking, which kills 480,000 people in the United States each year — e-cigarettes are creating another — hooking teenagers who have never smoked on nicotine. © 2018 The New York Times Company

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25446 - Posted: 09.13.2018

By Jan Hoffman BOSTON — To the medical students, the patient was a conundrum. According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he’d been prescribed. So why did his urine test positive for two other drugs — cocaine and hydromorphone, a powerful opioid that doctors had not ordered? It was up to Clark Yin, 29, to figure out what was really going on with Chris McQ, 58 — as seven other third-year medical students and two instructors watched. “How are you going to have a conversation around the patient’s positive tox screen results?” asked Dr. Lidya H. Wlasiuk, who teaches addiction awareness and interventions here at Boston University School of Medicine. Mr. Yin threw up his hands. “I have no idea,” he admitted. Chris McQ is a fictional case study created by Dr. Wlasiuk, brought to life for this class by Ric Mauré, a keyboard player who also works as a standardized patient — trained to represent a real patient, to help medical students practice diagnostic and communication skills. The assignment today: grappling with the delicate art and science of managing a chronic pain patient who might be tipping into a substance use disorder. How can a doctor win over a patient who fears being judged? How to determine whether the patient’s demand for opioids is a response to dependence or pain? Addressing these quandaries might seem fundamental in medical training — such patients appear in just about every field, from internal medicine to orthopedics to cardiology. The need for front-line intervention is dire: primary care providers like Dr. Wlasiuk, who practices family medicine in a Boston community clinic, routinely encounter these patients but often lack the expertise to prevent, diagnose and treat addiction. © 2018 The New York Times Company

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25433 - Posted: 09.11.2018

Elana Gordon As drug-related deaths rise to record numbers, at least a dozen U.S. cities are considering opening supervised injection sites, where people can use illicit drugs with trained staff present, ready to respond in case of an overdose. The future of such proposals in the U.S. is uncertain. A California bill that would greenlight a pilot injection site in San Francisco awaits the governor's signature, but a representative of the Justice Department vowed to crack down on any such site in recent public statements. Critics say supervised injection sites encourage drug use and bring crime to surrounding communities. Proponents argue that they save lives and can help people in addiction reconnect with society and get health services. Out with the dark alley, fear and shame, they say, in with a safe space, clean injection supplies, care and compassion. It's an approach that falls under the umbrella of harm reduction, a public health philosophy that emphasizes lessening the harms of drug use. But what does evidence say? If the policy goal is to save lives and eventually curb opioid addiction, do these sites work? It's a tricky question to answer, although many of these sites have been studied for years. At least 100 supervised injection sites operate around the world, mainly in Europe, Canada and Australia. Typically, drug users come in with their own drugs and are given clean needles and a clean, safe space to consume them. Staff are on hand with breathing masks and naloxone, the overdose antidote, and to provide safer injection advice and information about drug treatment and other health services. Cities Planning Supervised Drug Injection Sites Fear Justice Department Reaction July 12, 2018 © 2018 npr

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25425 - Posted: 09.08.2018

By Stephani Sutherland With nearly 50,000 drug overdose deaths from opioids last year and an estimated two million Americans addicted, the opioid crisis continues to rage throughout the U.S. This statistic must be contrasted with another: 25 million Americans live with daily chronic pain, for which few treatment options are available apart from opioid medications. Opioid drugs like morphine and Oxycontin are still held as the gold standard when it comes to relieving pain. But it has become brutally obvious that opioids have dangerous side effects, including physical dependence, addiction and the impaired breathing that too often leads to death from an overdose. Researchers have long been searching for a drug that would relieve pain without such a heavy toll, with few results so far. Now a study in monkeys published in Science Translational Medicine shows a new type of opioid drug met all the criteria on drug developers’ wish list. The findings even suggest that instead of causing addiction, the new compound might be used to curb addiction and pain all at once. The study was led by Mei-Chuan (Holden) Ko, a researcher at Wake Forest University, and medical chemist Nurulain Zaveri, founder of California-based Astraea Therapeutics. “They’ve got something here that’s really important,” says William Schmidt, a pharmaceutical consultantbased in Davis, Calif., who was not involved in the work. “I think the chances of a compound with these properties moving forward are high, and simultaneously pretty exciting.” © 2018 Scientific American

Related chapters from BN8e: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25422 - Posted: 09.07.2018

By Austin Frakt and Aaron E. Carroll The United States receives tremendous benefits from public health spending — with far more value per dollar than with most other types of health care spending. We reviewed those benefits in a recent article, suggesting that more such spending should be considered. Then Upshot readers weighed in with their choices of what public health campaigns they’d like to see. Those included more help for mothers and babies (the Nurse-Family Partnership), and a greater focus on diabetes, nutrition, gun deaths (including suicide), loneliness and the harms of sharing hypodermic needles. We asked some experts — officials who run public health departments, academics and leaders of funding organizations — what they think we should be doing in public health, and a few themes emerged. Overrating doctors and hospitals Although we spend huge sums on health care, it’s not always on the right things. “The key to better health isn’t always to build more hospitals and train more specialists,” said Vivek Murthy, the former surgeon general. “In fact, it usually is not.” That’s where public health comes in. Consider antismoking commercials late in the last century, for example. Or as Richard Besser, the president and chief executive of the Robert Wood Johnson Foundation, put it, public health has kept us safe “from infectious diseases through immunizations, information, mosquito control and food safety.” “It ensures that our water is safe to drink and our pools and lakes are safe for swimming,” he added. “It provides screening for cancer and works to prevent injuries.” Karen DeSalvo, a former New Orleans health commissioner, said: “Of the $1 trillion in federal spending, only 1 percent is on public health — an infrastructure that saves lives” and that can “reduce suffering and improve community well-being and vitality.” © 2018 The New York Times Company

Related chapters from BN8e: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25413 - Posted: 09.04.2018

By Daniel Victor On posters distributed to medical facilities across Australia, large type over an image of a pregnant woman read: “It’s safest not to drink while pregnant.” Good so far. It was the next line, in smaller type, that alarmed medical professionals: “It’s not known if alcohol is safe to drink when you are pregnant.” Public health groups responded with resounding protests — drinking alcohol while pregnant is very definitively known to be unsafe, they said. Creating doubt around the science could confuse pregnant women and encourage them to ignore warnings, they feared. The organization that made the posters, DrinkWise, describes its focus as promoting “a healthier and safer drinking culture in Australia,” but is funded largely by the alcohol industry. It withdrew the 2,400 posters after hearing complaints and substituted new text. But concerns remained among people working to spread the message that women should stay away from alcohol while pregnant. “It’s more than just erroneous for the alcohol industry to make that statement,” Michael Thorn, chief executive of the Foundation of Alcohol Research and Education, which is based in the Australian capital, Canberra, said in an interview. “The truth is, that’s what they want the public to believe.” In an emailed statement, DrinkWise’s chief executive, Simon Strahan, suggested the flap was more about precise messaging than intent. “It is clear, from the ‘It’s safest not to drink while pregnant’ headline of the posters, that the intent is to encourage abstinence when pregnant, planning a pregnancy or breast-feeding,” he said. © 2018 The New York Times Company

Related chapters from BN8e: Chapter 7: Life-Span Development of the Brain and Behavior; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 13: Memory, Learning, and Development; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25395 - Posted: 08.29.2018