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Rise in Deaths Spurs Effort to Raise Alcohol Taxes

By Ted Alcorn Oregon is a drinker’s paradise. The state boasts more craft distilleries than Kentucky and is second only to California in the number of wineries. Some call Portland “beervana” for its bevy of breweries. But Oregon also has among the highest prevalence of problem drinking in the country. Last year, 2,153 residents died of causes attributed to alcohol, according to the Oregon Health Authority — more than twice the number of people killed by methamphetamines, heroin and fentanyl combined. Sonja Grove, a retiree in Portland whose adult son drank himself to death in April 2020, feels the toll is overlooked compared with those of other drugs. “Alcoholism has sort of taken a back seat.” In 2021, confronted by these conflicting trends, as the pandemic raged on, Oregon lawmakers made it easier to drink. They permanently legalized the sale of to-go cocktails, which the Distilled Spirits Council of the United States called a “lifeline,” and increased the number of cases that wineries could ship directly to consumers. Reginald Richardson, director of the state’s Alcohol and Drug Policy Commission, described the policies as incongruent. “We obviously want to create an environment that’s pro-business, that helps the state to develop, but we’ve got this other thing,” he said. That disconnect is typical: Before Covid lockdowns, no state permitted bars or restaurants to deliver liquor to customers at home, according to a trade association. Now, 28 have relaxed the rules. In contrast, policies that experts consider most effective at curbing excessive drinking have been ignored. For example, even as alcohol-related deaths soared to record highs in the last few years, alcohol taxes have fallen to the lowest rates in a generation. Americans drank more during the pandemic, but national data on the change have only recently become available. Alcohol tax revenues collected by the U.S. Treasury Department rose by eight percent in the fiscal year that ended on Sept. 30, 2021, compared with the previous year, and remain well above pre-pandemic levels. © 2022 The New York Times Company

Related chapters from BN: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 4: Development of the Brain
Link ID: 28482 - Posted: 09.17.2022

Juul Settles Multistate Youth Vaping Inquiry for $438.5 Million

By Christina Jewett Juul Labs, fighting for its survival in the United States, on Tuesday tentatively agreed to pay $438.5 million to settle an investigation by nearly three dozen states over marketing and sales practices that they contend set off the nation’s teenage vaping crisis. The company said that it did not acknowledge any wrongdoing in the settlement, but that it was trying to “resolve issues from the past” while awaiting a decision by the Food and Drug Administration over whether it would be permitted to continue to sell its products. Juul has been trying to reposition itself as a seller of vaping products that could help adults quit smoking traditional cigarettes, in an effort to rehabilitate its tarnished reputation and improve its diminished market value. The tentative settlement prohibits the company from marketing to youth, funding education in schools and misrepresenting the level of nicotine in its products. But Juul had already discontinued several marketing practices and withdrawn many of its flavored pods that appealed to teenagers, under public pressure from lawmakers, parents and health experts a few years ago when the vaping crisis was at a peak. “We think that this will go a long way in stemming the flow of youth vaping,” William Tong, Connecticut’s attorney general, said at a news conference on Tuesday. “We are under no illusions and cannot claim that it will stop youth vaping. It continues to be an epidemic. It continues to be a huge problem. But we have essentially taken a big chunk out of what was once a market leader.” The multistate investigation found that the company appealed to young people by hiring young models, using social media to court teenagers and giving out free samples, he said. And, he added, the inquiry revealed that the company had a “porous” age verification system for its products and that 45 percent of its Twitter followers were ages 13 to 17. Jason Miyares, the attorney general for Virginia, pointed out in a statement that the company’s former strategy of selling flavors like mango and crème brûlée appealed to youth as did the sleek design of its device that was easy to conceal. One term of the settlement banned the company from depicting anyone under 35 in its marketing images, Mr. Miyares’ statement said. © 2022 The New York Times Company

This Teen Was Prescribed 10 Psychiatric Drugs. She’s Not Alone.

By Matt Richtel This article examines the increase in anxiety, depression, self harm and suicide among U.S. adolescents. Parents and teenagers dealing with these issues can find resources here. One morning in the fall of 2017, Renae Smith, a high school freshman on Long Island, N.Y., could not get out of bed, overwhelmed at the prospect of going to school. In the following days, her anxiety mounted into despair. “I should have been happy,” she later wrote. “But I cried, screamed and begged the universe or whatever godly power to take away the pain of a thousand men that was trapped inside my head.” Intervention for her depression and anxiety came not from the divine but from the pharmaceutical industry. The following spring, a psychiatrist prescribed Prozac. The medication offered a reprieve from her suffering, but the effect dissipated, so she was prescribed an additional antidepressant, Effexor. A medication cascade had begun. During 2021, the year she graduated, she was prescribed seven drugs. These included one for seizures and migraines — she experienced neither, but the drug can be also used to stabilize mood — and another to dull the side effects of the other medications, although it is used mainly for schizophrenia. She felt better some days but deeply sad on others. Her senior yearbook photo shows her smiling broadly, “but I felt terrible that day,” said Ms. Smith, who is now 19 and attends a local community college. “I’ve gotten good at wearing a mask.” She had come to exemplify a medical practice common among her generation: the simultaneous use of multiple heavy-duty psychiatric drugs. Psychiatrists and other clinicians emphasize that psychiatric drugs, properly prescribed, can be vital in stabilizing adolescents and saving the lives of suicidal teens. But, these experts caution, such medications are too readily doled out, often as an easy alternative to therapy that families cannot afford or find, or aren’t interested in. © 2022 The New York Times Company

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 4: Development of the Brain
Link ID: 28450 - Posted: 08.27.2022

Psilocybin Therapy Sharply Reduces Excessive Drinking, Small Study Shows

By Andrew Jacobs A small study on the therapeutic effects of using psychedelics to treat alcohol use disorder found that just two doses of psilocybin magic mushrooms paired with psychotherapy led to an 83 percent decline in heavy drinking among the participants. Those given a placebo reduced their alcohol intake by 51 percent. By the end of the eight-month trial, nearly half of those who received psilocybin had stopped drinking entirely compared with about a quarter of those given the placebo, according to the researchers. The study, published Wednesday in JAMA Psychiatry, is the latest in a cascade of new research exploring the benefits of mind-altering compounds to treat a range of mental health problems, from depression, anxiety and post-traumatic stress disorder to the existential dread experienced by the terminally ill. Although most psychedelics remain illegal under federal law, the Food and Drug Administration is weighing potential therapeutic uses for compounds like psilocybin, LSD and MDMA, the drug better known as Ecstasy. Dr. Michael Bogenschutz, director at NYU Langone Center for Psychedelic Medicine and the study’s lead investigator, said the findings offered hope for the nearly 15 million Americans who struggle with excessive drinking — roughly 5 percent of all adults. Excessive alcohol use kills an estimated 140,000 people each year. “These are exciting results,” Dr. Bogenschutz said. “Alcohol use disorder is a serious public health problem, and the effects of currently available treatments and medications tend to be small.” The double-blind randomized trial followed 93 participants for 32 weeks and divided them into two groups: One received psilocybin and the other a placebo in the form of antihistamine pills. The participants, all of whom struggled with excessive drinking, also took part in 12 therapy sessions that began several weeks before they received their first doses and continued for a month after the final dose. The psilocybin dosage was determined according to participants’ weight, and their heart rate and blood pressure were monitored during the eight-hour sessions. © 2022 The New York Times Company

Related chapters from BN: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 4: Development of the Brain; Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 28448 - Posted: 08.27.2022

Use of Marijuana and Psychedelics Is Soaring Among Young Adults

By Andrew Jacobs Marijuana and hallucinogen use among young adults reached an all-time record last year after having leveled off during the first year of the coronavirus pandemic, according to federal survey data. The findings, part of the government’s annual survey of drug use among young Americans, also found that nicotine vaping and excessive alcohol consumption continued to climb in 2021 after a brief pause. Another worrying trend among young people, ages 19 to 30: mounting consumption of alcoholic beverages suffused with THC, the psychoactive ingredient in cannabis. But there were some bright spots in the survey. Cigarette smoking and opioid abuse among young adults dropped last year, a continuing trend that has heartened public health experts. Taken in its entirety, the report provides a mixed picture of substance use in the United States that experts say reflects a number of disparate trends affecting young Americans: the devastating mental health effects of the pandemic; the increased availability of legal marijuana; and the emerging therapeutic embrace of psychedelics to treat depression, post-traumatic stress disorder and other psychological problems. “Overall, the results are very concerning,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which publishes the annual Monitoring the Future survey. “What they tell us is that the problem of substance abuse among young people has gotten worse in this country, and that the pandemic, with all its mental stressors and turmoil, has likely contributed to the rise.” The online survey of people ages 19 to 60 was conducted from April to October 2021. Substance use research experts said the mounting use of marijuana in young adults was especially notable. The survey found that 43 percent in the 19-30 age group had used cannabis 20 or more times over the previous month, up from 34 percent. In 2011, that figure was 29 percent. Daily marijuana consumption also jumped significantly, to 11 percent from 6 percent in 2011. © 2022 The New York Times Company

One of the Best Tools to Manage the Opioid Crisis Already Exists

By Emma Yasinski In the years since a family member of mine started taking methadone, a drug that helps him avoid the excruciating withdrawal symptoms and intense cravings that come with an opioid use disorder, he’s attended the funerals of three of his closest friends with whom he used to use drugs. The number of acquaintances he’s lost is in the double digits. Methadone might have saved them — if only they could have picked it up from their local pharmacy. Like heroin or oxycodone, methadone stimulates the opioid receptors in the brain. The difference is that while heroin rapidly floods these receptors leading to an intense high, the effect of methadone is more gradual and long-lasting. At the appropriate dose, my family member (whom I’m not naming due to the continued stigma surrounding opioids) and other patients can get full days of relief from pain, withdrawal, and cravings, without the intoxication. But methadone is tightly regulated. Rather than pick it up from the local pharmacy, patients have to visit a specialized clinic — often daily — to get each individual dose. In March 2020, concerns about Covid-19 led the Substance Abuse and Mental Health Services Administration, or SAMHSA, to relax those restrictions. The agency announced that states could request an exception allowing clinics to offer a greater amount of take-home doses— up to 28 days — for patients the clinical team believed were stable and could safely handle the medication. Some clinics embraced the opportunity. In a multistate survey of 170 opioid treatment programs, about half followed the relaxed SAMHSA guidelines for newly enrolled or less stable patients. And two-thirds of the clinics surveyed offered their stable patients a full four weeks of take-home doses. The pandemic provided the natural experiment to demonstrate that loosening regulations on methadone in the U.S. was safe for both patients and communities. More than two years later, on July 13, researchers at the National Institute on Drug Abuse and the National Center for Injury Prevention and Control published some of the most powerful results of that experiment. While deadly overdoses involving opioids rose to staggering heights in the U.S. during the first year of the pandemic, the percentage of overdose deaths involving methadone decreased.

An animal tranquilizer is making street drugs even more dangerous

Martha Bebinger Approaching a van that distributes safe supplies for drug use in Greenfield, Mass., a man named Kyle noticed an alert about xylazine. "Xylazine?" he asked, sounding out the unfamiliar word. "Tell me more." A street-outreach team from Tapestry Health delivered what's becoming a routine warning. Xylazine is an animal tranquilizer. It's not approved for humans, but it's showing up in about half of the drug samples that Tapestry tests in the rolling hills of western Massachusetts. It's appearing mostly in the illegal fentanyl supply but also in cocaine. Kyle rocked backward on his heels at the mention of cocaine. He and his friends regularly use cocaine, but lately, they had suspected that something else was in the bag. "The past week, we've all been just racking our brains, like 'What is going on?'" he said. "Because if we cook it up and we smoke it, we're falling asleep after." Kyle's deep sleep might have been triggered by fentanyl too, but Kyle said one of his buddies used a test strip to check for the opioid and none was detected. Xylazine surged first in some areas of Puerto Rico and then in Philadelphia, where it was found in 91% of opioid samples last year, the most recent reporting period. Data from January to mid-June shows that xylazine was in 28% of drug samples tested by the Massachusetts Drug Supply Data Stream (MADDS), a state-funded network of community drug-checking and advisory groups that uses mass spectrometers to let people know what's in bags or pills purchased on the street. Some areas of the state, including western Massachusetts, are seeing xylazine in 50% to 75% of samples. In Greenfield, that's a big change from last year, when xylazine wasn't a concern. © 2022 npr

Breaking Nicotine’s Powerful Draw

By Andrew Jacobs At some point in the next few years, the 30 million smokers in the United States could wake up one day to find that cigarettes sold at gas stations, convenience stores and smoke shops contain such minuscule amounts of nicotine that they cannot get their usual fix when lighting up. Would the smokers be plunged into the agonizing throes of nicotine withdrawal and seek out their favorite, full-nicotine brand on illicit markets, or would they turn to vaping, nicotine gum and other less harmful ways to get that angst-soothing rush? Such scenarios inched closer to the realm of possibility in June, when the Food and Drug Administration said that it would move toward slashing nicotine levels in cigarettes in an effort to reduce the health effects of an addiction that claims 480,000 lives a year. The agency set next May as its timetable for introducing a fully developed proposal. But many experts hope regulators will champion an immediate 95 percent reduction in nicotine levels — the amount federally funded studies have determined is most effective for helping smokers kick the habit. It could be years before any new policy takes effect, if it survives opposition from the tobacco industry. Even so, health experts say any effort to decrease nicotine in cigarettes to nonaddictive levels would be a radical experiment, one that has never been implemented by any other country. The science of nicotine addiction has come a long way since 1964, when a U.S. Surgeon General report first linked smoking to cancer and heart disease, although it would take another two decades for the mechanics of nicotine dependence to be understood and widely accepted. Tobacco contains more than 7,000 chemicals, many of them harmful when burned and inhaled, but it is nicotine that keeps smokers coming back for more. Nicotine stimulates a surge of adrenaline in the brain while indirectly producing a flood of dopamine, the chemical that promotes feelings of contentment and relaxation. The effects, however, are short-lived, which is why heavy smokers need a fresh injection a dozen or more times a day. © 2022 The New York Times Company

Regular coffee drinkers had lower chance of dying in 7-year period

By Linda Searing People who drink a moderate amount of coffee — up to 3½ cups a day — might have a better chance at a longer life span, even if their coffee is lightly sweetened with sugar, according to research published in Annals of Internal Medicine. For about seven years, the researchers tracked the coffee consumption and health of 171,616 participants, who were an average of nearly 56 years old and were free of cancer and cardiovascular disease when the study started. They found that those who regularly drank 1½ to 3½ cups of coffee a day, whether plain or sweetened with about a teaspoon of sugar, were up to 30 percent less likely to die in that time frame from any cause, including cancer and cardiovascular disease, than were those who did not drink coffee. The type of coffee — whether instant, ground or decaffeinated — made no difference, but the results were described as inconclusive for the use of artificial sweeteners. The latest research does not prove that coffee alone was responsible for participants’ lowered mortality risk. Still, over the years, research has revealed a variety of health benefits for coffee, linking its consumption to a reduced risk for Type 2 diabetes, Parkinson’s disease, depression and more. Nutritionists often attribute the benefits of coffee to the abundance of antioxidants in coffee beans, which may help reduce internal inflammation and cell damage and protect against disease. Drinking caffeinated coffee also provides an energy boost and increased alertness. Caffeine, however, can disrupt sleep and be risky during pregnancy.

Related chapters from BN: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 13: Homeostasis: Active Regulation of the Internal Environment
Related chapters from MM:Chapter 4: Development of the Brain; Chapter 9: Homeostasis: Active Regulation of the Internal Environment
Link ID: 28406 - Posted: 07.23.2022

With ‘How to Change Your Mind,’ Taking a Trip With Michael Pollan

By Chris Vognar Sign up for the Watching newsletter, for Times subscribers only. Streaming TV and movie recommendations from critic Margaret Lyons and friends. Get it in your inbox. In late 2012, the best-selling author and journalist Michael Pollan (“The Omnivore’s Dilemma”) was at a dinner party in Berkeley, Calif. Among his fellow diners was a prominent developmental psychiatrist, in her 60s, who spoke at some length about a recent LSD trip. This pricked up Pollan’s ears. His first thought, as he shared during a recent video interview: “People like that are taking LSD?” The psychiatrist went on to explain that the drug gave her a better understanding of the way children think. “Her hypothesis,” Pollan said, “was that the effects of psychedelics, LSD in that case, give us a taste of what child consciousness would be like — this kind of 360-degree taking-in of information, not particularly focused, fascinated by everything.” Pollan had already heard about clinical trials in which doctors were giving cancer patients psilocybin to help them deal with their fear of death. Now, he was really curious about psychedelic therapy. That curiosity became an article in The New Yorker (“The Trip Treatment,” 2015). The article became a book, “How to Change Your Mind” (2019). And now the book has become a four-part Netflix series of the same name, which debuted Tuesday. Pollan is an executive producer (along with the Oscar-winning filmmaker Alex Gibney) and the primary on-camera presence. A thoughtful and wide-ranging look at psychedelic therapy, the series is grounded in accounts of their centuries-long sacramental use and of their uneasy history in modern society, especially in the United States. In particular, it focuses on four substances — LSD, mescaline, MDMA (known as Ecstasy or Molly) and psilocybin (the active ingredient in magic mushrooms) — and the ways in which they are being used to treat patients with maladies including post-traumatic stress disorder, addiction, depression, anxiety and obsessive-compulsive disorder. © 2022 The New York Times Company

What Ethnographers Have Learned from People Who Use Drugs

By Ryan McDonald In color and consistency, black tar heroin is often compared to a Tootsie Roll. To become runny enough to pass through the point of a needle, a pellet of black tar must be heated in water to near boiling. After the drug has been injected, the syringes must be vigorously flushed to prevent the caramel-like residue from crystallizing. In the late 1990s and early 2000s, two researchers methodically recorded these details while trying to explain a lingering puzzle of the AIDS epidemic: why people who use injection drugs west of the Mississippi River had lower rates of HIV than similar individuals elsewhere. Their observations eventually formed the basis of a 2003 paper, which noted that from Houston, to Los Angeles, to Seattle, the majority of available heroin was black tar, rather than the powder form common on the East Coast. The paper’s authors hypothesized that, among other things, the boiling of water and flushing of needles reduced the probability of transmitting HIV through shared equipment. These observations and hypotheses were possible because the researchers, Philippe Bourgois and Dan Ciccarone, had immersed themselves among people who use heroin. In doing so, they were practicing ethnography, a research approach that seeks to understand how people think and behave in their natural environments through observation, interviews, and open-ended survey questions. Ethnographic research is conducted in a range of fields, including substance use and addiction. As the opioid epidemic stretches into a third decade and drug overdose deaths in the United States top 100,000 per year, some social scientists say this approach has taken on new urgency.

F.D.A. Aims to Cut Down on Smoking by Slashing Nicotine Levels in Cigarettes

By Christina Jewett and Andrew Jacobs The Food and Drug Administration is planning to require tobacco companies to slash the amount of nicotine in traditional cigarettes to make them less addictive and reduce the toll of smoking that claims 480,000 lives each year. The proposal, which could take years to go into effect, would put the United States at the forefront of global antismoking efforts. Only one other nation, New Zealand, has advanced such a plan. The headwinds are fierce. Tobacco companies have already indicated that any plan with significant reductions in nicotine would violate the law. And some conservative lawmakers might consider such a policy another example of government overreach, ammunition that could spill over into the midterm elections. Few specifics were released on Tuesday, but according to a notice published on a U.S. government website, a proposed rule would be issued in May 2023 seeking public comment on establishing a maximum nicotine level in cigarettes and other products. “Because tobacco-related harms primarily result from addiction to products that repeatedly expose users to toxins, F.D.A. would take this action to reduce addictiveness to certain tobacco products, thus giving addicted users a greater ability to quit,” the notice said. The F.D.A. declined to provide further details. But in a statement posted on its website, Dr. Robert M. Califf, the agency’s commissioner, said: “Lowering nicotine levels to minimally addictive or non-addictive levels would decrease the likelihood that future generations of young people become addicted to cigarettes and help more currently addicted smokers to quit.” “This one rule could have the greatest impact on public health in the history of public health,” said Mitch Zeller, the recently retired F.D.A. tobacco center director. “That’s the scope and the magnitude we’re talking about here because tobacco use remains the leading cause of preventable disease and death.” © 2022 The New York Times Company

Chewed and Rolled: How Cats Make the Most of Their Catnip High

By Oliver Whang Cats, so often, are a mystery, even to those that know them best. Why do they sleep so much? Why do they want your full attention one minute, none the next? How can they find their way back home after being stranded miles away for years? The writer Haruki Murakami, who is known for putting cats in his novels and essays, once confessed to not knowing why he does so; a cat “sort of naturally slips in,” he said. Another mystery: Why do cats love catnip? When exposed to the plant, which belongs to the mint family, the majority of domestic cats will lick it, rub against it, chew it and roll around in it. They brim with euphoria, getting high off the stuff. They also go wild for other plants, particularly silver vine, which is not closely related to catnip but elicits the same response from felines, including big cats like jaguars and tigers. For years, this behavior was just another cat-related enigma. But a new study, published Tuesday in the journal iScience, suggests that the reaction to catnip and silver vine might be explained by the bug repellent effect of iridoids, the chemicals in the plants that induce the high. Researchers, led by Masao Miyazaki, an animal behavior scientist at Iwate University in Japan, found that the amount of these iridoids released by the plant increased by more than 2,000 percent when the plant was damaged by cats. So perhaps kitty’s high confers an evolutionary advantage: keeping bloodsucking insects at bay. Kristyn Vitale, a cat behavior expert at Unity College who was not associated with the research, noted that the study built on strong previous work. Last year, the same lab published a study that found that cats would try their best to coat themselves in DEET-like iridoids, whether by rolling on the chemicals or by rising up to nuzzle them with their cheeks. “This indicates there may be a benefit to the cat physically placing the compounds on their body,” Dr. Vitale said. © 2022 The New York Times Company

They Were Cigarette Smokers. Then a Stroke Vanquished Their Addiction.

By Benjamin Mueller Taking a scan of an injured brain often produces a map of irretrievable losses, revealing spots where damage causes memory difficulties or tremors. But in rare cases, those scans can expose just the opposite: plots of brain regions where an injury miraculously relieves someone’s symptoms, offering clues about how doctors might accomplish the same. A team of researchers has now taken a fresh look at a set of such brain images, drawn from cigarette smokers addicted to nicotine in whom strokes or other injuries spontaneously helped them quit. The results, the scientists said, showed a network of interconnected brain regions that they believe underpins addiction-related disorders affecting potentially tens of millions of Americans. The study, published in the scientific journal Nature Medicine on Monday, supports an idea that has recently gained traction: that addiction lives not in one brain region or another, but rather in a circuit of regions linked by threadlike nerve fibers. The results may provide a clearer set of targets for addiction treatments that deliver electrical pulses to the brain, new techniques that have shown promise in helping people quit smoking. “One of the biggest problems in addiction is that we don’t really know where in the brain the main problem lies that we should target with treatment,” said Dr. Juho Joutsa, one of the study’s lead authors and a neurologist at the University of Turku in Finland. “We are hoping that after this, we have a very good idea of those regions and networks.” Research over the last two decades has solidified the idea that addiction is a disease of the brain. But many people still believe that addiction is voluntary. © 2022 The New York Times Company

Related chapters from BN: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 19: Language and Lateralization
Related chapters from MM:Chapter 4: Development of the Brain; Chapter 15: Language and Lateralization
Link ID: 28371 - Posted: 06.14.2022

As an ex-heroin addict, I know getting off opioids is near impossible

Perspective by Elizabeth Grey I’m told I don’t look like a heroin addict. I am a married, middle-aged woman, a taxpaying homeowner. As privilege goes, I have it. Because I’m White, I get treated better in medical settings such as hospitals and rehabs. I have health insurance. I have access to credit. My spouse could not be more supportive. But every day for a couple of years I left my house with a river view and drove downtown in South Yonkers to meet my dealer. I know a letter carrier who once worked that neighborhood. He told me there was a time when you could buy an Uzi on his route. I knew the first time I bought heroin at age 48 that doing so probably meant the end of my life. But compared to withdrawal, that was fine by me. Looks and bias may deceive, but numbers don’t lie. The United States hit a record of overdose deaths last year. And the great, gaping hole of the response to the opioid epidemic is that withdrawal is the most important aspect, and it’s barely given lip service. I often wonder how many suicides are a result of people unable to bear it. There is no net. The window of time between putting down the drug and even a whiff of hope is too long. The only place to land is hell. The medical community and lawmakers have never appreciated what withdrawal — or getting dopesick — does to a human being. Current policies and protocols can only manufacture heroin addicts. And I was a degenerate one. One day I noticed the inspection sticker on my car had expired. But it cost $37 to get an inspection, and that was almost four bags of heroin. I could not afford it. Every dollar went toward my growing habit. © 1996-2022 The Washington Post

Fentanyl Tainted Pills Bought on Social Media Cause Youth Drug Deaths to Soar

By Jan Hoffman Shortly after Kade Webb, 20, collapsed and died in a bathroom at a Safeway Market in Roseville, Calif., in December, the police opened his phone and went straight to his social media apps. There, they found exactly what they feared. Mr. Webb, a laid-back snowboarder and skateboarder who, with the imminent birth of his first child, had become despondent over his pandemic-dimmed finances, bought Percocet, a prescription opioid, through a dealer on Snapchat. It turned out to be spiked with a lethal amount of fentanyl. Mr. Webb’s death was one of nearly 108,000 drug fatalities in the United States last year, a record, according to preliminary numbers released this month by the Centers for Disease Control and Prevention. Law enforcement authorities say an alarming portion of them unfolded the same way as his: from counterfeit pills tainted with fentanyl that teenagers and young adults bought over social media. “Social media is almost exclusively the way they get the pills,” said Morgan Gire, district attorney for Placer County, Calif., where 40 people died from fentanyl poisoning last year. He has filed murder charges against a 20-year-old man accused of being Mr. Webb’s dealer, who pleaded not guilty. “About 90 percent of the pills that you’re buying from a dealer on social media now are fentanyl,” Mr. Gire said. The phenomenon has led to disturbing new statistics: Overdoses are now the leading cause of preventable death among people ages 18 to 45, ahead of suicide, traffic accidents and gun violence, according to federal data. Although experimental drug use by teenagers in the United States has been dropping since 2010, their deaths from fentanyl have skyrocketed, to 884 in 2021, from 253 in 2019, according to a recent study in the journal JAMA. Much as drug dealers in the 1980s and ’90s seized on pagers and burner phones to conduct business covertly, today’s suppliers have embraced modern iterations — social media and messaging apps with privacy features such as encrypted or disappearing messages. Dealers and young buyers usually spot each other on social media and then often proceed by directly messaging each other. © 2022 The New York Times Company

What is fentanyl and why is it behind the deadly surge in US drug overdoses?

Kavita Babu Buying drugs on the street is a game of Russian roulette. From Xanax to cocaine, drugs or counterfeit pills purchased in nonmedical settings may contain life-threatening amounts of fentanyl. Physicians like me have seen a rise in unintentional fentanyl use from people buying prescription opioids and other drugs laced, or adulterated, with fentanyl. Heroin users in my community in Massachusetts came to realize that fentanyl had entered the drug supply when overdose numbers exploded. In 2016, my colleagues and I found that patients who came to the emergency department reporting a heroin overdose often only had fentanyl present in their drug test results. As the Chief of Medical Toxicology at UMass Chan Medical School, I have studied fentanyl and its analogs for years. As fentanyl has become ubiquitous across the U.S., it has transformed the illicit drug market and raised the risk of overdose. Fentanyl and its analogs Fentanyl is a synthetic opioid that was originally developed as an analgesic – or painkiller – for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency. For example, carfentanil, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, acetylfentanyl, is approximately three times less potent than fentanyl, but has still led to clusters of overdoses in several states. © 2010–2022, The Conversation US, Inc.

Does online opioid treatment work?

By Lola Butcher While Covid-19’s death toll grabbed the spotlight these past two years, another epidemic continued marching grimly onward in America: deaths from opioid overdose. A record 68,630 individuals died from opioid overdoses in 2020, partly as a result of the isolation and social distancing forced by the pandemic; early data suggest that death rates in many states were even worse in the first half of 2021. But the coronavirus pandemic may also have had a paradoxical benefit for those addicted to opioids: Because Covid-19 made in-person health care unsafe, US telehealth regulations were relaxed so that more services — including addiction treatment — could be provided online. As a result, people with opioid use disorder are accessing medication and support across the country in greater numbers than ever before. While it’s too soon to know for sure whether this helps more people kick their addiction, early signs are promising. The federal government estimates that 2.7 million Americans — nearly 1 percent of the population — have opioid use disorder, also known as opioid addiction. It is a chronic brain disease that develops over time because of repeated use of prescription opioids such as hydrocodone, oxycodone and morphine or illicit fentanyl and heroin. A person with opioid use disorder has a 20 times greater risk of death from overdose, infectious diseases, trauma and suicide than one who does not. Fortunately, two medications — methadone and buprenorphine, both approved by the US Food & Drug Administration — help individuals manage withdrawal symptoms and control or eliminate their compulsive opioid use. Patients who receive these medications fare better than those who do not on a long list of outcomes, says Eric Weintraub, who heads the Division of Alcohol and Drug Abuse at the University of Maryland School of Medicine. They have fewer overdoses; less injection drug use; reduced risk for disease transmission; decreased criminal activity; lower rates of illegal drug use; and better treatment-retention rates. Indeed, people with opioid use disorder receiving long-term treatment with methadone or buprenorphine are up to 50 percent less likely to die from an overdose. © 2022 Annual Reviews

Dopamine Drives Bee Desires

Natalia Mesa Cravings for sugary treats and other “wants” in humans are driven by the activity of dopamine-producing cells in our mesolimbic system. Experimental research now suggests that a similar system might also exist in honeybees (Apis mellifera), spurring them to “want” to search for sources of nectar. In a study published today (April 28) in Science, researchers found that bees’ dopamine levels were elevated during the search for food and dropped once the food was consumed. Dopamine may also help trigger a hedonic, or pleasant, “memory” of the sugary treat, the researchers say, as dopamine levels rose again when foragers danced to tell other foragers about the foods’ locations. “The whole story is new. To show that there is a wanting system in insects is generally new,” says study coauthor Martin Giurfa, a neuroscientist at Paul Sabatier University in Toulouse, France. “Bees are truly amazing.” In both humans and invertebrates, dopamine is known to be involved in learning and reward. Giurfa and his team have been studying the neurotransmitter in bees, and several years ago, they characterized many of the neural pathways that involved dopamine. “We found so many so diverse pathways that we said, ‘There might be more than just representing reinforcement, representing punishment, representing reward.’” He began to look for other roles dopamine might play in honeybee behavior. bee next to pink flower © 1986–2022 The Scientist.

Related chapters from BN: Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology; Chapter 6: Evolution of the Brain and Behavior
Related chapters from MM:Chapter 4: Development of the Brain
Link ID: 28305 - Posted: 04.30.2022

Teen drug overdose deaths rose sharply in 2020, driven by fentanyl-laced pills

Rhitu Chatterjee For the first time in a decade, overdose deaths among teens in the United States rose dramatically in 2020 and kept rising through 2021 as well. That's according to the results of a new study published Tuesday in JAMA. "This is very alarming because what we've seen in other parts of the population is that when overdose death rates start to rise, they tend to continue to do so for quite some time," says Joe Friedman, a public health researcher at the University of California, Los Angeles, and the lead author of the new study. "We're still really in the early days in terms of teen overdose. And that makes this an especially important time to intervene," he adds. Friedman and his colleagues found that fatal overdoses among adolescents nearly doubled from 492 in 2019 to 954 in 2020, an increase of 94%. There was an additional 20% rise in 2021 compared to the previous year. The highest rates were among Native American and Alaskan Native teens, followed by Latino teens. "For decades, we've seen overdose rates rising among adults, and teens have been insulated from that," says Friedman. "And now, for the first time, the overdose crisis is reaching teens as well." It appears that the rise in deaths was fueled not by greater numbers of teens using drugs – substance use in this age group actually went down during the pandemic – but by use of dangerous and highly potent forms of fentanyl. The study found that fentanyl-related deaths increased from 253 in 2019 to 680 the following year. And in 2021, 77% of all teen overdose deaths involved fentanyl. © 2022 npr

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