Chapter 4. The Chemistry of Behavior: Neurotransmitters and Neuropharmacology

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Viviane Callier Our human brains can seem like a crowning achievement of evolution, but the roots of that achievement run deep: The modern brain arose from hundreds of millions of years of incremental advances in complexity. Evolutionary biologists have traced that progress back through the branch of the animal family tree that includes all creatures with central nervous systems, the bilaterians, but it is clear that fundamental elements of the nervous system existed much earlier. How much earlier has now been made dramatically clear by a recent discovery by a team of researchers at the University of Exeter in the United Kingdom. They found that the chemical precursors of two important neurotransmitters, or signaling molecules used in nervous systems, appear in all the major animal groups that preceded creatures with central nervous systems. The big surprise, however, is that these molecules are also present in single-celled relatives of animals, called choanoflagellates. This finding shows that animal neuropeptides originated before the evolution of even the very first animals. The discovery “solves a long-standing question about when and how animal neuropeptides evolved,” said Pawel Burkhardt, who studies the evolutionary origin of neurons at the Sars International Center for Marine Molecular Biology in Norway. It also indicates that at least some of the signaling molecules fundamental to the operation of our brains first evolved for an entirely different purpose in organisms that consisted of only a single cell. Animal nervous systems are made of neurons that connect to each other, zipping information across synapses with a variety of small peptide neurotransmitters. These peptides are the language with which neurons speak to each other. All Rights Reserved © 2022

Keyword: Development of the Brain
Link ID: 28354 - Posted: 06.04.2022

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

Keyword: Drug Abuse
Link ID: 28340 - Posted: 05.28.2022

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

Keyword: Drug Abuse
Link ID: 28334 - Posted: 05.21.2022

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.

Keyword: Drug Abuse
Link ID: 28323 - Posted: 05.11.2022

Perspective by Susan Berger As I faced a prophylactic double mastectomy in hopes of averting cancer, I had many questions for my surgeons — one of which was about pain. I was stunned when both my breast surgeon and plastic surgeon said that a nerve block would leave me pain-free for about three days, after which the worst of the pain would be over. Pectoralis nerve (PECS) blocks were developed to provide analgesia or pain relief for chest surgeries, including breast surgery. That is what happened. I went through the mastectomy Dec. 1 after learning I had the PALB2 gene mutation that carried a sharply elevated risk of breast cancer as well as a higher risk of ovarian and pancreatic cancers. I also had my fallopian tubes and ovaries removed in July. I had learned about the gene mutation in April 2021, when one of my daughters found out she was a carrier. As a 24-year breast cancer survivor and longtime health reporter, I was astonished that I had heard nothing about this mutation. I researched it and wrote “This Breast Cancer Gene Is Less Well Known, but Nearly as Dangerous” in August. After the double mastectomy, I also wrote about it for The Washington Post. Just as my surgeons at NorthShore University HealthSystem predicted, I was released from the hospital the same day as my surgery and remarkably pain-free. I took one Tramadol (a step down from stronger medications containing codeine) when I got home — only because it was suggested I take one pill. As I recovered, I only took Advil and Tylenol. The opioid epidemic is a major public health issue in the United States and nerve blocks could be a solution. According to a study published in the Journal of Clinical Medicine in 2021, 1 in 20 surgical patients will continue to use opioids beyond 90 days. “There is no association with magnitude of surgery, major versus minor, and the strongest predictor of continued use is surgical exposure,” the study states. © 1996-2022 The Washington Post

Keyword: Pain & Touch; Drug Abuse
Link ID: 28316 - Posted: 05.07.2022

By Jim Robbins TUCSON, Ariz. — In a small room in a building at the Arizona-Sonora Desert Museum, the invertebrate keeper, Emma Califf, lifts up a rock in a plastic box. “This is one of our desert hairies,” she said, exposing a three-inch-long scorpion, its tail arced over its back. “The largest scorpion in North America.” This captive hairy, along with a swarm of inch-long bark scorpions in another box, and two dozen rattlesnakes of varying species and sub- species across the hall, are kept here for the coin of the realm: their venom. Efforts to tease apart the vast swarm of proteins in venom — a field called venomics — have burgeoned in recent years, and the growing catalog of compounds has led to a number of drug discoveries. As the components of these natural toxins continue to be assayed by evolving technologies, the number of promising molecules is also growing. “A century ago we thought venom had three or four components, and now we know just one type of venom can have thousands,” said Leslie V. Boyer, a professor emeritus of pathology at the University of Arizona. “Things are accelerating because a small number of very good laboratories have been pumping out information that everyone else can now use to make discoveries.” She added, “There’s a pharmacopoeia out there waiting to be explored.” It is a striking case of modern-day scientific alchemy: The most highly evolved of natural poisons on the planet are creating a number of effective medicines with the potential for many more. One of the most promising venom-derived drugs to date comes from the deadly Fraser Island funnel web spider of Australia, which halts cell death after a heart attack. Blood flow to the heart is reduced after a heart attack, which makes the cell environment more acidic and leads to cell death. The drug, a protein called Hi1A, is scheduled for clinical trials next year. In the lab, it was tested on the cells of beating human hearts. It was found to block their ability to sense acid, “so the death message is blocked, cell death is reduced, and we see improved heart cell survival,” said Nathan Palpant, a researcher at the University of Queensland in Australia who helped make the discovery. © 2022 The New York Times Company

Keyword: Pain & Touch; Neurotoxins
Link ID: 28315 - Posted: 05.04.2022

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

Keyword: Drug Abuse
Link ID: 28313 - Posted: 05.04.2022

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.

Keyword: Drug Abuse; Evolution
Link ID: 28305 - Posted: 04.30.2022

By Brittany Shammas and Timothy Bella William Husel, an Ohio doctor who was accused of killing 14 patients with what prosecutors described as “wildly excessive” doses of fentanyl between 2015 and 2018, was acquitted on all counts of murder Wednesday, concluding one of the most significant murder cases of its kind against a health-care professional. Husel, a onetime physician of the year trained at the Cleveland Clinic, faced one count of murder for each of the 14 critically ill patients he was accused of killing. The jury deliberated for seven days before finding him not guilty on all 14 counts in what was one of the largest murder trials in Ohio history. He had been charged with causing or hastening their deaths amid a period of lax oversight of fentanyl at Mount Carmel West, a Catholic hospital in Columbus. Husel would have faced life in prison with just one guilty verdict. While the synthetic opioid is significantly more powerful than morphine and has wreaked havoc on American streets, it can provide pain relief in medical settings that is crucial to end-of-life care. The alleged victims in the Ohio case suffered critical medical conditions including overdoses, cancer, strokes and internal bleeding. Prosecutors acknowledged that all were being kept alive on ventilators and that many of them were dying. “In truth, William Husel was an innocent man, and thank goodness the justice system prevailed,” Jose Baez, one of Husel’s defense attorneys, told reporters. The 46-year-old’s acquittal came after a two-month trial that triggered a debate on end-of-life medical care. Husel and Baez argued in the trial that the doctor offered comfort care for dying patients and was not trying to kill them. They pointed out that the doctor’s actions did not occur in secret — nurses were the ones to administer the doses — and alleged that hospital officials made Husel the villain after realizing the systemic failures at play. The fallout over the allegations at Mount Carmel West had repercussions: the firing of 23 employees; the resignation of the hospital’s chief executive, chief clinical officer and chief pharmacy officer; and Medicare and Medicaid funding for the institution was put in jeopardy. © 1996-2022 The Washington Post

Keyword: Pain & Touch; Drug Abuse
Link ID: 28297 - Posted: 04.23.2022

By Andrew Jacobs Psychedelic compounds like LSD, Ecstasy and psilocybin mushrooms have shown significant promise in treating a range of mental health disorders, with participants in clinical studies often describing tremendous progress taming the demons of post-traumatic stress disorder, or finding unexpected calm and clarity as they face a terminal illness. But exactly how psychedelics might therapeutically rewire the mind remains an enigma. A group of neuroscientists in London thought advanced neuroimaging technology that peered deep into the brain might provide some answers. They included 43 people with severe depression in a study sponsored by Imperial College London, and gave them either psilocybin, the active ingredient in magic mushrooms, or a conventional antidepressant; the participants were not told which one they would receive. Functional magnetic resonance imaging, which captures metabolic function, took two snapshots of their brain activity — the day before receiving the first dose and then roughly three weeks after the final one. What they found, according to a study published Monday in the journal Nature Medicine, was illuminating, both figuratively and literally. Over the course of three weeks, participants who had been given the antidepressant escitalopram reported mild improvement in their symptoms, and the scans continued to suggest the stubborn, telltale signs of a mind hobbled by major depressive disorder. Neural activity was constrained within certain regions of the brain, a reflection of the rigid thought patterns that can trap those with depression in a negative feedback loop of pessimism and despair. By contrast, the participants given psilocybin therapy reported a rapid and sustained improvement in their depression, and the scans showed flourishes of neural activity across large swaths of the brain that persisted for the three weeks. That heightened connectivity, they said, resembled the cognitive agility of a healthy brain that, for example, can toggle between a morning bout of melancholia, a stressful day at work and an evening of unencumbered revelry with friends. © 2022 The New York Times Company

Keyword: Depression; Drug Abuse
Link ID: 28283 - Posted: 04.13.2022

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

Keyword: Drug Abuse
Link ID: 28281 - Posted: 04.13.2022

By Gina Kolata Last week, two patients asked Dr. Stanley L. Hazen, a cardiologist at the Cleveland Clinic, how much daily alcohol consumption would be good for their cardiac health. He gave them both well-accepted medical advice — an average of about one drink a day helps the heart. “I didn’t give it a second thought,” he said. Then he saw a paper published in JAMA Network Open whose findings upended his thinking about what to tell patients. The paper, he said, “totally changes my life.” Its conclusion: There is no level of drinking that does not confer heart disease risk. The risk is small if people have an average of seven drinks a week when compared with none. But it increases quickly as the level of alcohol consumption rises. “Dose matters a lot,” said Dr. Krishna G. Aragam, a preventive cardiologist at Massachusetts General Hospital and an author of the study. “Just realize that, as you go up beyond modest ranges, the risk goes up quite a bit.” The study, which may help resolve medical disputes over the effects of alcohol on the heart, involved sophisticated analyses of the genes and medical data of nearly 400,000 people who participate in the U.K. Biobank, a British repository that investigators use to study genes and their relation to health. The average age of subjects selected for the alcohol study was 57, and they reported consuming an average of 9.2 drinks a week. Some researchers have reported that drinking modestly protects the heart because moderate drinkers as a group have less heart disease than those who drink heavily or those who abstain. Dr. Aragam and his colleagues also saw that effect. But the reason, they report, is not that alcohol protects the heart. It is that light to moderate drinkers — those who consume up to 14 drinks a week — tend to have other characteristics that decrease their risk, like smoking less, exercising more and weighing less than those who drink more heavily and those who do not drink. © 2022 The New York Times Company

Keyword: Drug Abuse
Link ID: 28260 - Posted: 03.30.2022

By Roni Caryn Rabin Almost a million people in the United States have died of Covid-19 in the past two years, but the full impact of the pandemic’s collateral damage is still being tallied. Now a new study reports that the number of Americans who died of alcohol-related causes increased precipitously during the first year of the pandemic, as routines were disrupted, support networks frayed and treatment was delayed. The startling report comes amid a growing realization that Covid’s toll extends beyond the number of lives claimed directly by the disease to the excess deaths caused by illnesses left untreated and a surge in drug overdoses, as well as to social costs like educational setbacks and the loss of parents and caregivers. Numerous reports have suggested that Americans drank more to cope with the stress of the pandemic. Binge drinking increased, as did emergency room visits for alcohol withdrawal. But the new report found that the number of alcohol-related deaths, including from liver disease and accidents, soared, rising to 99,017 in 2020, up from 78,927 the previous year — an increase of 25 percent in the number of deaths in one year. That compares with an average annual increase of 3.6 percent in alcohol-related deaths between 1999 and 2019. Deaths started inching up in recent years, but increased only 5 percent between 2018 and 2019. The study, done by researchers with the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health, was published in The Journal of the American Medical Association on Friday. Using information from death certificates, the researchers included all deaths in which alcohol was listed as an underlying or contributing cause. (Only a very small number also involved Covid-19.) “The assumption is that there were lots of people who were in recovery and had reduced access to support that spring and relapsed,” said Aaron White, the report’s first author and a senior scientific adviser at the alcohol abuse institute. © 2022 The New York Times Company

Keyword: Drug Abuse; Stress
Link ID: 28253 - Posted: 03.26.2022

Allison Whitten Every time you reach for your coffee mug, a neuroscientific mystery takes shape. Moments before you voluntarily extend your arm, thousands of neurons in the motor regions of your brain erupt in a pattern of electrical activity that travels to the spinal cord and then to the muscles that power the reach. But just prior to this massively synchronized activity, the motor regions in your brain are relatively quiet. For self-driven movements like reaching for your coffee, the “go” signal that tells the neurons precisely when to act — instead of the moment just before or after — has yet to be found. In a recent paper in eLife, a group of neuroscientists led by John Assad at Harvard Medical School finally reveals a key piece of the signal. It comes in the form of the brain chemical known as dopamine, whose slow ramping up in a region lodged deep below the cortex closely predicted the moment that mice would begin a movement — seconds into the future. Dopamine is commonly known as one of the brain’s neurotransmitters, the fast-acting chemical messengers that are shuttled between neurons. But in the new work, dopamine is acting as a neuromodulator. It’s a term for chemical messengers that slightly alter neurons to cause longer-lasting effects, including making a neuron more or less likely to electrically communicate with other neurons. This neuromodulatory tuning mechanism is perfect for helping to coordinate the activity of large populations of neurons, as dopamine is likely doing to help the motor system decide precisely when to make a movement. The new paper is one of the latest results to expand our knowledge of the crucial and varied roles that neuromodulators play in the brain. With recent advances in technology, neuroscientists can now view neuromodulators at work in networks that traverse the entire brain. The new findings are overturning some long-held views about these modulators adrift in the brain, and they’re revealing exactly how these molecules allow the brain to flexibly change its internal state amid ever-changing environments. All Rights Reserved © 2022

Keyword: Movement Disorders; Drug Abuse
Link ID: 28251 - Posted: 03.23.2022

Brian Mann Nine state attorneys general have agreed to drop their objection to a deal granting immunity from opioid lawsuits to members of the Sackler family who own Purdue Pharma, the maker of OxyContin. In exchange, the family has agreed to increase the amount it pays from personal holdings from roughly $4.5 billion under a previous settlement to $6 billion. Washington state Attorney General Robert Ferguson described the terms of the new settlement as a victory. "Rather than join the majority of states in settlement, Washington chose to lead the fight against the Sacklers and Purdue," Ferguson said in a statement. "As a result, we won more than $100 million for Washington state to address the opioid epidemic, and more than $1 billion for states, cities and tribes across the country." The prior deal was overturned by a federal judge in Manhattan last December after some states and the Justice Department filed an appeal. States demanding more money from the Sacklers — California, Connecticut, Delaware, Maryland, New Hampshire, Oregon, Vermont and Washington — have among the highest overdose death rates in the country. In a statement, members of various branches of the Sackler family again denied any wrongdoing and described the settlement as one that will "allow very substantial additional resources to reach people and communities in need." "While the families have acted lawfully in all respects, they sincerely regret that OxyContin, a prescription medicine that continues to help people suffering from chronic pain, unexpectedly became part of an opioid crisis that has brought grief and loss to far too many families and communities." Critics, including many of the state attorneys general who approved this deal, have long accused members of the Sackler family of aggressively marketing opioids in ways that contributed to soaring rates of addiction and overdoses. © 2022 npr

Keyword: Drug Abuse
Link ID: 28230 - Posted: 03.05.2022

By Jan Hoffman For years, Dr. Xiulu Ruan was one of the nation’s top prescribers of quick-release fentanyl drugs. The medicines were approved only for severe breakthrough pain in cancer patients, but Dr. Ruan dispensed them almost exclusively for more common ailments: neck aches, back and joint pain. According to the Department of Justice, he and his partner wrote almost 300,000 prescriptions for controlled substances from 2011 to 2015, filled through the doctors’ own pharmacy in Mobile, Ala. Dr. Ruan often signed prescriptions without seeing patients, prosecutors said. Dr. Ruan has been serving a 21-year sentence in federal prison, convicted in 2017 for illegally prescribing opioids and related financial crimes. To collect millions of dollars in fines, the government seized houses, beach condos and bank accounts belonging to him and his business partner, as well as 23 luxury cars, such as Bentleys, Lamborghinis and Ferraris. On Tuesday, lawyers both for Dr. Ruan and for Dr. Shakeel Kahn, who is serving 25 years on charges related to pill mill clinics in Arizona and Wyoming will argue before the Supreme Court of the United States that the criminal standard the physicians faced is applied inconsistently among the federal circuits. In asking that the doctors’ convictions be overturned, they want the court to establish a uniform standard that permits doctors to raise a “good faith” defense. Juries could then consider whether doctors subjectively believed they were using their best medical judgment. The likelihood of these two doctors being set free is small, legal experts believe, but the court’s decision on the broader legal questions could have significant implications for the latitude doctors can take in prescribing potentially addictive painkillers and other restricted medications. The cases confront an uneasy relationship between law and medicine. In an era when overdose deaths are soaring, how should the law balance letting physicians exercise their best judgment with stopping egregious outliers? © 2022 The New York Times Company

Keyword: Drug Abuse; Pain & Touch
Link ID: 28226 - Posted: 03.02.2022

Brian Mann Over the next two weeks, some of the biggest U.S. corporations accused of "turbocharging" the opioid epidemic could finalize payouts to victims and governments worth roughly $32 billion. "We've lost more than a million Americans to this epidemic, and sadly, it's at an all-time high as overdose deaths continue to rise," said Texas Attorney General Ken Paxton last week, in a statement announcing his state is now in line to receive roughly $1.1 billion. Paxton said pharmaceutical companies that made, distributed and sold opioids were "at the root of the problem." Their payments will help fund "treatment for those currently still struggling with opioid addiction," he added. This comes as communities across the U.S. are scrambling for resources to combat an opioid crisis that keeps getting worse. Drug overdoses killed more than 104,000 Americans in the most recent 12-month period for which data is available, according to the Centers for Disease Control and Prevention. That's a tragic new record for the U.S. There are two major negotiations nearing completion. The largest involves major drug distributors and wholesalers AmerisourceBergen, Cardinal Health and McKesson, along with health products giant Johnson & Johnson. Article continues after sponsor message The four firms, which maintain they did nothing wrong, have tentatively agreed to payouts totaling $26 billion. The Texas money would come from that deal, as would roughly $590 million that would go to Native American tribes. © 2022 npr

Keyword: Drug Abuse
Link ID: 28216 - Posted: 02.23.2022

By Jan Hoffman The federal government on Thursday proposed new guidelines for prescribing opioid painkillers that remove its previous recommended ceilings on doses for chronic pain patients and instead encourage doctors to use their best judgment. But the overall thrust of the recommendations was that doctors should first turn to “nonopioid therapies” for both chronic and acute pain, including prescription medications like gabapentin and over-the-counter ones like ibuprofen, as well as physical therapy, massage and acupuncture. Though still in draft form, the 12 recommendations, issued by the Centers for Disease Control and Prevention, are the first comprehensive revisions of the agency’s opioid prescribing guidelines since 2016. They walk a fine line between embracing the need for doctors to prescribe opioids to alleviate some cases of severe pain while guarding against exposing patients to the well-documented perils of opioids. Dr. Samer Narouze, president of the American Society of Regional Anesthesia and Pain Medicine, an association of clinicians, praised the tone, level of detail and focus of the project. “It’s a total change in the culture from the 2016 guidelines,” he said, characterizing the earlier edition as ordering doctors to “just cut down on opioids — period.” By contrast, the new proposal “has a much more caring voice than a policing one, and it’s left room to preserve the physician-patient relationship,” added Dr. Narouze, chairman of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls, OH. The 229-page document warns of addiction, depressed breathing, altered mental status and other dangers associated with opioids, but it also notes that the drugs serve an important medical purpose, especially for easing the immediate agony from traumatic injuries such as burns and crushed bones. In those instances when opioids seem the way to go, the recommendations said, doctors should start with the lowest effective dose and prescribe immediate-release pills rather than long-acting ones. © 2022 The New York Times Company

Keyword: Drug Abuse; Pain & Touch
Link ID: 28207 - Posted: 02.16.2022

By Emma Yasinski By the time kids diagnosed with attention deficit hyperactivity disorder meet with clinical psychologist Mary O’Connor, they have often been taking multiple medications or unusually high doses of stimulants like Ritalin. “They may have had a trial of stimulants that worked initially,” she says, but when the effect waned, their physicians prescribed higher doses, sometimes to the point of toxicity. O’Connor researches fetal alcohol spectrum disorders at the University of California, Los Angeles, where she has provided both diagnosis and treatment to children exposed to alcohol in the womb. At one end of the spectrum sits fetal alcohol syndrome, characterized by facial abnormalities, growth problems, and intellectual disabilities. The other end of the spectrum is characterized by subtler symptoms, including poor judgement and impulsivity — in other words, what looks to many like ADHD. But experts say standard ADHD treatments often don’t work as well for children exposed to alcohol in-utero. And lack of awareness, a shortage of specialists, and social stigma have combined to limit families’ ability to receive an accurate diagnosis and support for FASD, a condition that is underdiagnosed in the United States and could affect between 1 and 5 percent of this country’s children. The lack of diagnoses, scientists say, stifles research on treatments and may even cloud data on therapies for other disorders.

Keyword: ADHD; Drug Abuse
Link ID: 28206 - Posted: 02.16.2022

By Elizabeth Landau My grandmother was in the advanced stages of Alzheimer’s disease when she died in 2007, not long after I graduated from journalism school. As a budding health reporter, I tried to learn everything I could about Alzheimer’s and wrote about new research on preventions and treatments that everyone wanted to believe had potential. It is demoralizing and infuriating to think about how, nearly 15 years later, no breakthrough cure or proven prevention strategy has panned out. But neurologist Sara Manning Peskin argues in “A Molecule Away from Madness: Tales of the Hijacked Brain” that we could be on the brink of a revolution in confronting diseases like this because scientists have a better handle on how molecules work in the brain. Molecular research has transformed our understanding and treatment of cancer in recent years, and now it is beginning to do the same for brain diseases. In fact, it has already been key to solving several mysteries of why seemingly healthy people appear to suddenly fall into a mental inferno. While the shadow of Alzheimer’s looms over the book, representing an intractable condition that Peskin routinely confronts in her clinical practice, “A Molecule Away from Madness” is a fascinating tour of different kinds of ways that the brain can lead to the breakdown of mental life. The book is organized according to how different molecules interact with our brains to wreak havoc — Peskin calls them “mutants, rebels, invaders, and evaders.” Some have helped scientists solve longstanding puzzles, while others, like the molecules associated with Alzheimer’s, continue to leave millions of people waiting for a cure.

Keyword: Alzheimers
Link ID: 28196 - Posted: 02.12.2022