Links for Keyword: Drug Abuse

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In San Francisco, Opioid Addiction Treatment Offered on the Streets

By Abby Goodnough The addiction treatment program at Highland Hospital’s emergency room is only one way that cities and health care providers are connecting with people in unusual settings. Another is in San Francisco, where city health workers are taking to the streets to find homeless people with opioid use disorder and offering them buprenorphine prescriptions on the spot. The city is spending $6 million on the program in the next two years, partly in response to a striking increase in the number of people injecting drugs on sidewalks and in other public areas. Most of the money will go toward hiring 10 new clinicians for the city’s Street Medicine Team, which already provides medical care for the homeless. Members of the team will travel around the city offering buprenorphine prescriptions to addicted homeless people, which they can fill the same day at a city-run pharmacy. At the end of a recent yearlong pilot, about 20 of the 95 participants were still taking buprenorphine under the care of the street medicine team. Dr. Barry Zevin, the city’s medical director for Street Medicine and Shelter Health, hopes to provide buprenorphine to 250 more people through the program. That’s only a tiny fraction of the estimated 22,500 people in San Francisco who actively inject drugs, he said, but it’s a start. What follows is a condensed, edited interview with Dr. Zevin, who has been providing medical care to the homeless in San Francisco since 1991. Why offer buprenorphine on the streets instead of in a medical clinic? Most health care for the homeless happens under the model of waiting for people to come in to a health center. But a lot of people never come in. There are a lot of mental health, substance abuse and cognitive problems in this population, a lot of chronic illness. Appointments are the enemy of homeless people. On the street there are no appointments, and no penalties or judgments for missing appointments. © 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: 25354 - Posted: 08.20.2018

An Overdose Left Him With Brain Damage. Now What?

By Daniela J. Lamas NORTH ANDOVER, Mass. — It was a Sunday afternoon, and in the cozy house at the end of the street, Andrew Foote sat in his usual chair while a movie played on the television. The young man’s hands rested on two pillows, wrists bent and fingers contracted into fists. From time to time, he rocked forward as if to stand but then collapsed backward, into the chair. His few words were slow and slurred. The simple fact that Andrew was living at home is somewhat miraculous. Heroin and fentanyl caused him to stop breathing, but he learned to breathe on his own again. His kidneys failed and then recovered. But Andrew’s brain, starved of oxygen too long, was left severely damaged. More than four years have passed since the overdose. For Andrew’s parents, the fear that their son will die has now been replaced by a new set of realities and unanswerable questions: Is this a good life? Is he happy? What will happen to him when they grow old? In the opioid epidemic, outcomes like Andrew’s are a largely unseen casualty. “People think that if you overdose on drugs, you either die or you’re O.K.,” his mother, Linda Foote, told me. “But that’s not true.” Andrew was a golden child. He was the oldest of four, a high school football star who remained humble despite the trophies that decorated his room — now alongside a urinary catheter, pill boxes and equipment for his feeding tube. “How many touchdowns did you make in high school?” his mother prompted. His long-term memory had remained relatively preserved, though it was hard for him to call up the words. As we waited, my gaze traveled to a framed collage of family photos. There was Andrew in his letterman’s jacket, blond hair cut short, lips curled upward in a shy smile. He was still a handsome guy. Mrs. Foote took pride in this, but his expression had dimmed. © 2018 The New York Times Company

This E.R. Treats Opioid Addiction on Demand. That’s Very Rare

By Abby Goodnough OAKLAND, Calif. — Every year, thousands of people addicted to opioids show up at hospital emergency rooms in withdrawal so agonizing it leaves them moaning and writhing on the floor. Usually, they’re given medicines that help with vomiting or diarrhea and sent on their way, maybe with a few numbers to call about treatment. When Rhonda Hauswirth arrived at the Highland Hospital E.R. here, retching and shaking violently after a day and a half without heroin, something very different happened. She was offered a dose of buprenorphine on the spot. One of three medications approved in the United States to treat opioid addiction, it works by easing withdrawal symptoms and cravings. The tablet dissolved under her tongue while she slumped in a plastic chair, her long red hair obscuring her ashen face. Soon, the shakes stopped. “I could focus a little more. I could see straight,” said Ms. Hauswirth, 40. “I’d never heard of anyone going to an emergency room to do that.” Highland, a clattering big-city hospital where security wands constantly beep as new patients get scanned for weapons, is among a small group of institutions that have started initiating opioid addiction treatment in the E.R. Their aim is to plug a gaping hole in a medical system that consistently fails to provide treatment on demand, or any evidence-based treatment at all, even as more than two million Americans suffer from opioid addiction. According to the latest estimates, overdoses involving opioids killed nearly 50,000 people last year. By providing buprenorphine around the clock to people in crisis — people who may never otherwise seek medical care — these E.R.s are doing their best to ensure a rare opportunity isn’t lost. “With a single E.R. visit we can provide 24 to 48 hours of withdrawal suppression, as well as suppression of cravings,” said Dr. Andrew Herring, an emergency medicine specialist at Highland who runs the buprenorphine program. “It can be this revelatory moment for people — even in the depth of crisis, in the middle of the night. It shows them there’s a pathway back to feeling normal.” © 2018 The New York Times Company

Babies Born Dependent On Opioids Need Touch, Not Tech

Alex Smith Dr. Jodi Jackson has worked for years to address infant mortality in Kansas. Often, that means she is treating newborns in a high-tech neonatal intensive care unit with sophisticated equipment whirring and beeping. That is exactly the wrong place for an infant like Lili. Lili's mother, Victoria, used heroin for the first two-thirds of her pregnancy and hated herself for it. (NPR is using her first name only, because she has used illegal drugs.) "When you are in withdrawal, you feel your baby that's in withdrawal too," says Victoria, recalling the sensations she remembers from her pregnancy. "You feel your baby uncomfortable inside of you, and you know that. And then you use and then the baby's not [uncomfortable], and that's a really awful, vulgar thought, but it's true. That's how it is. It's terrible." Though Victoria went into recovery before giving birth, Lili was born dependent on the methadone Victoria took to treat her opioid addiction. Treatment for infants like Lili has evolved, Jackson says. "What happened 10, 15 years ago, is [drug dependent] babies were immediately removed from the mom, and they were put in an ICU warmer with bright lights with nobody holding them," says Jackson, who is a neonatologist at Children's Mercy Hospital in Kansas City, Missouri. "Of course, they are going to be upset about that! And so the risk of withdrawal is much higher." © 2018 npr

Designed to deceive: How gambling distorts reality and hooks your brain

Mike Robinson To call gambling a “game of chance” evokes fun, random luck and a sense of collective engagement. These playful connotations may be part of why almost 80 percent of American adults gamble at some point in their lifetime. When I ask my psychology students why they think people gamble, the most frequent suggestions are for pleasure, money or the thrill. While these might be reasons why people gamble initially, psychologists don’t definitely know why, for some, gambling stops being an enjoyable diversion and becomes compulsive. What keeps people playing even when it stops being fun? Why stick with games people know are designed for them to lose? Are some people just more unlucky than the rest of us, or simply worse at calculating the odds? As an addiction researcher for the past 15 years, I look to the brain to understand the hooks that make gambling so compelling. I’ve found that many are intentionally hidden in how the games are designed. And these hooks work on casual casino-goers just as well as they do on problem gamblers. Uncertainty as its own reward in the brain One of the hallmarks of gambling is its uncertainty – whether it’s the size of a jackpot or the probability of winning at all. And reward uncertainty plays a crucial role in gambling’s attraction. Dopamine, the neurotransmitter the brain releases during enjoyable activities such as eating, sex and drugs, is also released during situations where the reward is uncertain. In fact dopamine release increases particularly during the moments leading up to a potential reward. © 2010–2018, The Conversation US, Inc.

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: 25328 - Posted: 08.14.2018

Pregnant women’s use of opioids is on the rise

Leah Rosenbaum Pregnant women aren’t immune to the escalating opioid epidemic. Data on hospital deliveries in 28 U.S. states shows the rate of opioid use among pregnant women has quadrupled, from 1.5 per 1,000 women in 1999 to 6.5 per 1,000 women in 2014, the U.S. Centers for Disease Control and Prevention reports. The highest increases in opioid use among pregnant women were in Maine, New Mexico, Vermont and West Virginia, according to the CDC study, published online August 9 in Morbidity and Mortality Weekly Report. “This analysis is a stark reminder that the U.S. opioid crisis is taking a tremendous toll on families,” says coauthor Jean Ko, a CDC epidemiologist in Atlanta. In this first look at opioid use during pregnancy by state, Washington, D.C. had the lowest rate in 2014, at 0.7 per 1,000 women, and Vermont had the highest, at 48.6 per 1,000. However, the data from the U.S. Health and Human Services Department represents only the 28 states that record opioid use at childbirth during the studied time frame. “We knew the incidence was increasing” as the number of babies going through opioid withdrawal has also gone up, says Matthew Grossman, a pediatrician at Yale University. Overall, the number of U.S. deaths attributed to opioids has also been steadily rising (SN: 3/31/18, p. 18). In 2014, there were 14.7 opioid deaths per 100,000 people, up from 6.2 per 100,000 in 2000, according to the CDC. © Society for Science & the Public 2000 - 2018

Fentanyl drug deaths rise by nearly a third in England and Wales

Frances Perraudin Deaths caused by the drug fentanyl rose by nearly 30% last year, according to figures from the Office for National Statistics. While statistics show that the rate of deaths from drug poisoning in England and Wales has remained steady – 66.1 deaths per 1 million people (3,756 deaths) – fatalities involving the synthetic opioid fentanyl were up 29%. There were 75 deaths in 2017, up from 58 deaths in 2016. Fentanyl has been found mixed with street heroin, causing accidental overdose in users. The drug can up to 100 times stronger than heroin and is sometimes prescribed as a painkiller for the terminally ill. One type of fentanyl, carfentanyl, is 10,000 times stronger and is used as an elephant tranquilliser. It was first seen mentioned in death certificates in 2017 and accounted for 27 deaths, 87% of the 31 deaths related to types of fentanyl in 2017. In April 2017, after a spate of deaths linked to fentanyl in northern England, Public Health England issued a warning to heroin users to be extra careful when using the drug, urging them to test a small amount first and not to take it alone. The ONS statistics also show that deaths from cocaine were up for the sixth year in a row. There were 432 deaths related to the drug in 2017, compared with 371 deaths in 2016. In June a report by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) found that purity of street cocaine across Europe was at its highest level in a decade and the number of people seeking treatment for use of the drug was on the rise. © 2018 Guardian News and Media Limited

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: 25295 - Posted: 08.06.2018

F.D.A. Did Not Intervene to Curb Risky Fentanyl Prescriptions

By Emily Baumgaertner WASHINGTON — A fast-acting class of fentanyl drugs approved only for cancer patients with high opioid tolerance has been prescribed frequently to patients with back pain and migraines, putting them at high risk of accidental overdose and death, according to documents collected by the Food and Drug Administration. The F.D.A. established a distribution oversight program in 2011 to curb inappropriate use of the dangerous medications, but entrusted enforcement to a group of pharmaceutical companies that make and sell the drugs. Some of the companies have been sued for illegally promoting other uses for the medications and in one case even bribing doctors to prescribe higher doses. About 5,000 pages of documents, obtained by researchers at the Johns Hopkins Bloomberg School of Public Health through the Freedom of Information Act and provided to The New York Times, show that the F.D.A. had data showing that so-called off-label prescribing was widespread. But officials did little to intervene. “If any opioids were going to be tightly regulated, it would be these,” said Dr. Andrew Kolodny, an opioid policy researcher at Brandeis University, who was not involved in the investigation. “They had the fox guarding the henhouse, people were getting hurt — and the F.D.A. sat by and watched this happen.” Officials at the F.D.A. said they had reviewed evidence indicating that many patients without cancer were given the drugs. But they said that piecemeal data from various stakeholders — prescriber surveys, insurance claims and industry reports — made it difficult for the agency to measure potential harm to patients. “The information we have isn’t very good, but it seems to indicate people who aren’t cancer patients are getting this and people who aren’t opioid tolerant are getting this,” Dr. Janet Woodcock, the director of the Center for Drug Evaluation and Research at the F.D.A., said in an interview. © 2018 The New York Times Company

How and why people 'microdose' tiny hits of psychedelic drugs

Illegal, underground and said to be brimming with health benefits — the practice of microdosing psychedelic drugs is growing increasingly popular, yet it remains relatively unstudied and its reported benefits unproven. A group of Canadian researchers is hoping to change that with new data that begins to shed light on how and why people microdose, and what they say are its effects and drawbacks. Microdosing is the practice of taking minute doses of hallucinogens like LSD or psilocybin (the active compound in so-called magic mushrooms) for therapeutic purposes. The amounts are too small to produce a high but large enough to quell anxiety or improve mood, according to users. Researchers at the University of Toronto, York University and Toronto's Centre for Addiction and Mental Health collaborated on the study, which they say is the first of its kind. The team targeted microdosing communities on Reddit and other social media channels with an anonymous online survey last year. They received 909 completed responses from current and former microdosers as well as others who had no experience with the practice. The survey yielded information about how much and how often people microdosed: typically 10 to 20 micrograms of LSD (about one- or two-tenths of a tab) or 0.2 to 0.5 grams of dried magic mushrooms, about once every three days or once per week. Thomas Anderson presented the findings at the Beyond Psychedelics conference in Prague in June. Those who microdosed reported a number of benefits, including improved mood, increased focus and productivity, and better connection with others. ©2018 CBC/Radio-Canada.

Controversial US ketamine trial sparks ethics complaint

Sara Reardon A consumer-advocacy group is filing a complaint with the US government about two clinical trials in Minnesota that allegedly gave agitated patients ketamine and other sedatives without their consent, despite evidence that doing so could harm their health. The trials were conducted by researchers at Hennepin County Medical Center (HCMC) in Minneapolis, Minnesota, between 2014 and June 2018. In its complaint, the advocacy group Public Citizen in Washington DC alleges that the studies’ organizers and the HCMC’s ethics-review board allowed the trials to proceed without obtaining consent from patients. In both studies, paramedics responding to medical emergencies injected agitated people with either ketamine or another sedative to determine which drug worked fastest. Patients were only notified afterwards that they had received a sedative. Sixty-four doctors, bioethicists and academic researchers have co-signed Public Citizen’s complaint, which the group plans to submit to the US Office for Human Research Protections (OHRP) and the Food and Drug Administration (FDA) on 25 July. “This isn’t even a close call,” says Michael Carome, director of Public Citizen’s health-research group. “This is clearly a prospective, high-risk experiment. This is really just a colossal failure of their programme to protect human subjects.” A spokesperson for Hennepin Healthcare, which operates Hennepin County Medical Center, told Nature that the hospital will not comment on the studies until after ongoing internal and external investigations are complete. © 2018 Springer Nature Limited.

This Parasite Drugs Its Hosts With the Psychedelic Chemical in Shrooms

Ed Yong Imagine emerging into the sun after 17 long years spent lying underground, only for your butt to fall off. That ignominious fate regularly befalls America’s cicadas. These bugs spend their youth underground, feeding on roots. After 13 or 17 years of this, they synchronously erupt from the soil in plagues of biblical proportions for a few weeks of song and sex. But on their way out, some of them encounter the spores of a fungus called Massospora. A week after these encounters, the hard panels of the cicadas’ abdomens slough off, revealing a strange white “plug.” That’s the fungus, which has grown throughout the insect, consumed its organs, and converted the rear third of its body into a mass of spores. The de-derriered insects go about their business as if nothing unusual has happened. And as they fly around, the spores rain down from their exposed backsides, landing on other cicadas and saturating the soil. “We call them flying saltshakers of death,” says Matt Kasson, who studies fungi at West Virginia University. Massospora and its butt-eating powers were first discovered in the 19th century, but Kasson and his colleagues have only just shown that it has another secret: It doses its victims with mind-altering drugs. Perhaps that’s why “the cicadas walk around as if nothing’s wrong even though a third of their body has fallen off,” Kasson says.

A quarter of adults with sprained ankles were prescribed opioids in the ER

by Lenny Bernstein A quarter of the adults who went to hospital emergency departments with sprained ankles were prescribed opioid painkillers, a new study shows, in another sign of how commonly physicians turn to narcotics even for minor injuries. The state-by-state review revealed wide variation in the use of opioids for the sprains, from 40 percent in Arkansas to 2.8 percent in North Dakota. All but one of the nine states that recorded above-average opioid prescribing are in the South or Southwest. None are in the parts of Appalachia or New England that have been hit hardest by the opioid epidemic. The analysis of 30,832 private insurance claims from 2011 to 2015 revealed that emergency department prescriptions can influence long-term opioid use. The median prescription was 15 tablets, or three days’ worth of hydrocodone, oxycodone, tramadol or other narcotics. Patients who received the largest amounts were five times as likely to continue with prolonged opioid use than those given 10 tablets or fewer, though their overall numbers were relatively small. The recipients were not known to have previously used opioids. Opioid prescriptions written by emergency room doctors are responsible for a small portion of the vast amount of narcotic painkillers consumed by patients each year. Most prescriptions come from primary-care physicians. There were about 215 million prescriptions for the drugs in 2016, according to the Centers for Disease Control and Prevention. © 1996-2018 The Washington Post

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: 25264 - Posted: 07.28.2018

V.A. Shuns Medical Marijuana, Leaving Vets to Improvise

By Dave Philipps SANTA CRUZ, Calif. — Some of the local growers along the coast here see it as an act of medical compassion: Donating part of their crop of high-potency medical marijuana to ailing veterans, who line up by the dozens each month in the echoing auditorium of the city’s old veterans’ hall to get a ticket they can exchange for a free bag. One Vietnam veteran in the line said he was using marijuana-infused oil to treat pancreatic cancer. Another said that smoking cannabis eased the pain from a recent hip replacement better than prescription pills did. Several said that a few puffs temper the anxiety and nightmares of post-traumatic stress disorder. “I never touched the stuff in Vietnam,” said William Horne, 76, a retired firefighter. “It was only a few years ago I realized how useful it could be.” The monthly giveaway bags often contain marijuana lotions, pills, candies and hemp oils, as well as potent strains of smokable flower with names like Combat Cookies and Kosher Kush. But the veterans do not get any medical guidance on which product might help with which ailment, how much to use, or how marijuana might interact with other medications. Ordinarily, their first stop for advice like that would be the Department of Veterans Affairs health system, with its thousands of doctors and hundreds of hospitals and clinics across the country dedicated to caring for veterans. But the department has largely said no to medical marijuana, citing federal law. It won’t recommend cannabis products for patients, and for the most part it has declined even to study their potential benefits. That puts the department out of step with most of the country, where at least 30 states now have laws that allow the use of medical marijuana in some form. © 2018 The New York Times Company

What if a Study Showed Opioids Weren’t Usually Needed?

By Aaron E. Carroll Promising health studies often don’t pan out in reality. The reasons are many. Research participants are usually different from general patients; their treatment doesn’t match real-world practice; researchers can devote resources not available in most physician offices. Moreover, most studies, even the gold standard of randomized controlled trials, focus squarely on causality. They are set up to see if a treatment will work in optimal conditions, what scientists call efficacy. They’re “explanatory.” Efficacy is important. But what we also need are studies that test if a treatment will work in the real world — if they have effectiveness. These different kinds of studies actually exist. They are called pragmatic trials, and a recent one might have helped serve as a brake as the opioid epidemic accelerated. Pragmatic trial design was described more than 50 years ago in the Journal of Chronic Diseases (in a paper reprinted nine years ago in the Journal of Clinical Epidemiology). A pragmatic trial seeks to determine if, and how, an intervention might work in practice, where decisions are more complicated than in a strictly controlled clinical trial. Studies are almost never purely pragmatic or explanatory: They fall on a continuum. A recent tool, known as Precis-2, can help researchers devise trials to lean one way or the other. It’s scored on nine domains — eligibility criteria, recruitment, setting, organization, flexibility (delivery), flexibility (adherence), follow-up, primary outcome and primary analysis — on a scale from 1 (explanatory, or “ideal conditions”) to 5 (pragmatic, or “real world”). Why do we need all this? Let’s take chronic pain as an example. Those who suffer from it want relief, and they want it now. Because people know that opioids exist, it’s hard to get them into a trial where they might take less powerful pain medications, like acetaminophen or ibuprofen. It’s also hard to do the long-term studies we need, because patients often want to try other options if the first one doesn’t work. © 2018 The New York Times Company

A Spike In Liver Disease Deaths Among Young Adults Fueled By Alcohol

Paul Chisholm Dr. Elliot Tapper has treated a lot of patients, but this one stood out. "His whole body was yellow," Tapper remembers. "He could hardly move. It was difficult for him to breathe, and he wasn't eating anything." The patient was suffering from chronic liver disease. After years of alcohol use, his liver had stopped filtering his blood. Bilirubin, a yellowish waste compound, was building up in his body and changing his skin color. Disturbing to Tapper, the man was only in his mid-30s – much younger than most liver disease patients. Tapper, a liver specialist and assistant professor of medicine at the University of Michigan Medical School, tried to get the patient to stop drinking. "We had long, tearful conversations," Tapper says, "but he continued to struggle with alcohol addiction." Since then, the young man's condition has continued to deteriorate and Tapper is not optimistic about his chances of survival. It's patient stories like this one that led Tapper to research liver disease in young people. According to a study published Wednesday in BMJ by Tapper and a colleague, fatal liver disease has risen, and young people have been hit the hardest. The study examined the number of deaths resulting from cirrhosis, or scarring of the liver, as well as liver cancer. Data came from the Centers for Disease Control and Prevention and covered the period from 1999 to 2016. © 2018 npr

by Kate Furby Deaths from liver disease have increased sharply in recent years in the United States, according to a study published in the British Medical Journal. Cirrhosis-related deaths increased by 65 percent from 1999 to 2016, and deaths from liver cancer doubled, the study said. The rise in death rates was driven predominantly by alcohol-induced disease, the report said. Over the past decade, people ages 25 to 34 had the highest increase in cirrhosis deaths — an average of 10.5 percent per year — of the demographic groups examined, researchers reported. The study suggests that a new generation of Americans is being afflicted "by alcohol misuse and its complications,” said lead author Elliot Tapper, a liver specialist at the University of Michigan. Tapper said people are at risk of life-threatening cirrhosis if they drink several drinks a night or have multiple nights of binge drinking — more than four or five drinks per sitting — per week. Women tend to be less tolerant of alcohol and their livers more sensitive to damage. The liver cleans blood as it exits the gut. The more toxins, sugars and fats consumed, the harder it has to work. If the liver gets overloaded, its plumbing can get blocked up, causing scarring that can reduce liver function. "Dying from cirrhosis, you never wish this on anybody," Tapper said. © 1996-2018 The Washington Post

A Major Industry-Funded Alcohol Study Was Compromised. How Many Others Are Out There?

/ By Jeremy Samuel Faust Last year, the National Institute on Alcohol Abuse and Alcoholism, part of the federal National Institutes of Health, laid out plans for what is a rarity in the realm of public health: a high quality clinical trial. The “Moderate Alcohol and Cardiovascular Health Trial,” known as MACH15, was to be randomized so that some subjects would be selected to drink and some would not. It would follow participants “prospectively,” over time, not retrospectively. And in the end, the results were to be adjudicated by evaluators blinded to which subjects had been instructed to drink and which to abstain. The goal was an assessment of the effect of alcohol consumption on cardiovascular health. The methodologic problems of the MACH15 trial’s design are considerable. How the outcome measures ever passed muster defies logic. But last month, the National Institutes of Health took the unusual step of shutting down one of its own clinical trials — a $100 million dollar experiment gone wrong. The announcement followed an internal investigation, prompted by a dogged New York Times report, that uncovered inappropriate interactions between the alcohol industry (Anheuser-Busch InBev, Heineken, and others) and the NIAAA in the execution of MACH15. By law, federal health agencies can receive funding from for-profit industry. But direct courting of funding, coordination, and collaboration on research design, and excessive communications are not permitted, and according to The Times and the findings of the NIH’s subsequent internal investigation, these violations occurred early and often during the development of the MACH15 trial. The NIH report concluded that the actions uncovered “calls into question the impartiality of the process and thus casts doubt that the scientific knowledge gained from the study would be actionable or believable.” Copyright 2018 Undark

Coming soon to a lab near you? Genetically modified cannabis

Amy Maxmen Legal hurdles to exploring marijuana’s medicinal properties might soon fall in the wake of the US Food and Drug Administration’s (FDA) first approval of a cannabis-derived drug. On 25 June, the FDA announced its approval of Epidiolex — a treatment for epileptic seizures that is based on a cannabis compound called cannabidiol (CBD). The US Drug Enforcement Administration (DEA) has until 24 September to re-classify Epidiolex so that it’s legal for doctors across the country to prescribe it. Many researchers hope that the agency will re-classify CBD itself, instead of just Epidiolex, so that they can more easily study this non-psychedelic component of marijuana. Now that the FDA has approved Epidiolex, “we have a clear recognition that this plant has more potential than people credited it for, and that has reverberations that are scientific as well as legal”, says Daniele Piomelli, director of a new centre for cannabis research at the University of California, Irvine. At the very least, he says, the DEA ought to grant researchers an exemption permitting them to study CBD — especially now that people consume it and other cannabis compounds, known as cannabinoids, in states where marijuana is legal. At this point, the limits on research seem irrational, he adds. Lessening restrictions on the study of CBD would also be good news for biotech startups that have been producing cannabinoids through genetic engineering. These products could be purer and more affordable than those obtained through older methods of extraction from marijuana plants or chemical synthesis. © 2018 Springer Nature Limited.

The number of people admitted to hospital in Scotland with alcohol-related brain damage has reached a 10-year high. A total of 661 people required treatment for brain injury after alcohol misuse between 2016-17, the equivalent of nearly two people a day. Alcohol-related brain damage can lead to problems with memory and learning. NHS Greater Glasgow and Clyde had the most admissions at 230, followed by 99 in NHS Lothian. The figures were released in response to a parliamentary question by the Scottish Conservative health spokesman Miles Briggs. He said it was worrying that the statistics were continuing to rise despite efforts to combat alcohol misuse. He said: "Scotland already has one of the worst records in Europe for alcohol consumption and, despite increased awareness, the problem only seems to be getting worse." He added: "The decision by SNP ministers to cut funding for alcohol and drug partnerships was wrong, and has clearly impacted on the delivery of services to support people addicted to alcohol." © 2018 BBC. T

Use of ‘smart drugs’ on the rise

Arran Frood The use of drugs by people hoping to boost mental performance is rising worldwide, finds the largest ever study of the trend. In a survey of tens of thousands of people, 14% reported using stimulants at least once in the preceding 12 months in 2017, up from 5% in 2015. The non-medical use of substances — often dubbed smart drugs — to increase memory or concentration is known as pharmacological cognitive enhancement (PCE), and it rose in all 15 nations included in the survey. The study looked at prescription medications such as Adderall and Ritalin — prescribed medically to treat attention deficit hyperactivity disorder (ADHD) — as well as the sleep-disorder medication modafinil and illegal stimulants such as cocaine. The work, published in the International Journal of Drug Policy1 in June, is based on the Global Drug Survey — an annual, anonymous online questionnaire about drug use worldwide. The survey had 79,640 respondents in 2015 and 29,758 in 2017. US respondents reported the highest rate of use: in 2017, nearly 30% said they had used drugs for PCE at least once in the preceding 12 months, up from 20% in 2015. But the largest increases were in Europe: use in France rose from 3% in 2015 to 16% in 2017; and from 5% to 23% in the United Kingdom (see ‘Quest for cognitive enhancement’). An informal reader survey by Nature in 2008 found that one in five respondents had used drugs to boost concentration or memory. The latest analysis is impressive in its size, says Barbara Sahakian, a neuroscientist at the University of Cambridge, UK, who was not involved in the work. There is an increasing ‘lifestyle use’ of cognitive-enhancing drugs by healthy people, which raises ethical concerns, she says. © 2018 Springer Nature Limited.

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