opioid addiction Archives - Amazing Health Advances

Low-Dose Ketamine Eases Fentanyl Withdrawal Symptoms

The AHA! Team — Thu, 17 Oct 2024 08:22:08 +0000

University of Washington School of Medicine via News-Medical – Drug overdose is the leading cause of injury deaths in young adults in the United States, with fentanyl causing over 70,000 deaths annually. Many people who use fentanyl become trapped in their addiction out of fear and a low tolerance for the withdrawal symptoms, which include muscle cramps, nausea, chills, sweats and intense cravings. They can’t stop using fentanyl, and they also have trouble starting either of the two medications, methadone and buprenorphine, that can dramatically reduce their risk of overdose death. Research findings published Aug. 29 in Addiction Science & Clinical Practice may offer hope. A pilot study showed that a small amount of ketamine can reduce or eliminate the withdrawal symptoms associated with quitting fentanyl. “The main takeaway is that we have found an easier way for people trapped in the grip of fentanyl addiction to get started in treatment.” Dr. Lucinda Grande, clinical assistant professor of family medicine, University of Washington School of Medicine She was the study’s lead author. “Methadone can be difficult to access due to strict federal regulations, and starting buprenorphine can cause severe withdrawal symptoms before those who start it become stabilized,” added study co-author Dr. Tom Hutch. He is the medical director of the opioid treatment program at We Care Daily Clinics in Auburn, Wash. “Ketamine, at an imperceptibly low dose, helps bridge that gap.” Over 14 months, Grande and colleagues in Auburn and Olympia prescribed ketamine to 37 fentanyl-addicted patients whose fear of withdrawal symptoms had deterred them from trying buprenorphine. Twenty-four patients actually tried the drug, and 16 completed the transition to buprenorphine. Most patients reported a reduction or elimination of withdrawal symptoms after each ketamine dose, the effect of which lasted for hours. Of the last 12 who completed the transition, 92% remained in treatment for at least 30 days. Patients placed a ketamine lozenge or syrup under the tongue. The 16 mg dose is a small fraction of that typically used for anesthesia, the main clinical role of ketamine for 50 years, according to Grande. That dosage also is less than half of the smallest ketamine dose prescribed for depression treatment, an increasingly common use of this medication. Researchers monitored patients daily or almost daily, and refined the treatment strategy based on patient response and prescriber experience. Grande developed the concept after she learned that emergency-medicine physician and coauthor Dr. Andrew Herring of Oakland, California, used a higher, sedating dose of ketamine successfully in his emergency department to resolve a patient’s severe case of withdrawal from fentanyl addiction. Grande is a primary-care and addiction doctor in practice near Olympia who, in the past dozen years, has used low-dose ketamine to treat more than 600 patients for chronic pain and depression. Ketamine has gained prominence in the news since actor Matthew Perry of the sitcom “Friends” overdosed on the drug and drowned. Perry had undergone high-dose ketamine treatment for depression, news reports have suggested. “Our study underscores the enormous potential of this medication for addressing important health problems such as depression, chronic pain and now fentanyl-use disorder,” said Grande. Ketamine’s positive attributes have been overshadowed by Perry’s death, she said. Grande hopes this pilot study’s results will be confirmed by larger studies. “I am excited about these results,” she said. “This is a wonderful opportunity to save lives.” Source: University of Washington School of Medicine Journal reference: Grande, L., et al. (2024) Ketamine-assisted buprenorphine initiation: a pilot case series. Addiction Science & Clinical Practice. doi.org/10.1186/s13722-024-00494-2. To read the original article click here.

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Opioid Dependence Found to Permanently Change Brains of Rats

AHA Publisher — Fri, 07 Feb 2020 08:00:56 +0000

University of California San Diego Health via Newswise – Approximately one-quarter of patients who are prescribed opioids for chronic pain misuse them, with five to 10 percent developing an opioid use disorder or addiction. In a new study, UC San Diego researchers found that opioid dependence produced permanent changes in the brains of rats. Newswise — More specifically, researchers reported that dependence on oxycodone, a potent opioid painkiller, led to permanent neuro-adaptations of the central nucleus of the amygdala (CeA) at the level of the nociceptin system, a brainwide network that modulates transmission of pain. Downregulation or suppression of the nociceptin system in the CeA led to an increase in activation of GABA receptors in rats highly addicted to opioids. The discovery is consistent with previous findings reporting CeA neuroa-daptations after cocaine and alcohol dependence. When researchers restored nociceptin levels in the CeA, it resulted in normalization of GABAergic transmission and a reduction of the rats’ opioid consumption. “This suggests the nociceptin system may be a promising target for the treatment of opioid use disorder,” said senior author Giordano de Guglielmo, PharmD, PhD, assistant professor in the Department of Psychiatry at UC San Diego School of Medicine. “To reveal the role of nociceptin in the central nucleus of the amygdala, we used a multidisciplinary approach with behavioral models, molecular biology and electrophysiology,” said first author Marsida Kallupi, PharmD, PhD, assistant professor in the Department of Psychiatry. “That allowed us to conclude that downregulation of this peptide may be partially responsible for excessive opioid addiction-like behaviors.” Currently, opioid maintenance therapy is the first-line treatment for opioid dependence, which involves using alternative, less damaging medications, such as methadone, buprenorphine and naltrexone. These three drugs are the only treatments approved by the U.S. Food and Drug Administration, but all have limitations, either because they act against different receptors, pose safety concerns or are less effective due to the need for strict adherence to treatment. Both methadone and buprenorphine target mu-opioid receptors in the brain. The new research builds upon past behavioral and neurochemical studies suggesting the nociceptin system and its receptors (NOP) are also involved in opioid tolerance and reward, addiction to multiple drugs and modulation of stress. Interestingly, while the research demonstrates that NOP is implicated in development of opioid dependence, it conversely blocks effects of morphine-based opioids. De Guglielmo said several efforts are already underway testing small molecule drugs that target the nociception system, and have produced positive effects in reducing alcohol-seeking behaviors and biology in rats. The new findings indicate they may offer similar potential therapeutic benefit for opioid addiction. Every day, according to the National Institute on Drug Abuse, more than 130 people in the United States die after overdosing on opioids. Two out of three drug overdose deaths involve an opioid. From 1999 to 2017, the last year for which data is available, almost 400,000 Americans lost their lives to opioids, with 47,600 fatal overdoses in 2017 alone. It’s estimated 2.1 million Americans have an opioid use disorder. To read the original article click here.

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Mindfulness May Reduce Opioid Cravings, Study Finds

AHA Publisher — Wed, 16 Oct 2019 07:00:19 +0000

Rutgers University-New Brunswick via New Wise – Opioid users, chronic pain sufferers may experience fewer relapses and greater well-being. Newswise — People suffering from opioid addiction and chronic pain may have fewer cravings and less pain if they use both mindfulness techniques and medication for opioid dependence, according to Rutgers and other researchers. The study, published in the journal Drug and Alcohol Dependence, examined the effects of mindfulness and methadone therapy on 30 patients with opioid addiction and chronic pain. Mindfulness is the meditative practice of focusing on the present moment and accepting one’s thoughts, feelings and bodily sensations, without judgement. The findings showed that those who received methadone and a mindfulness training-based intervention were 1.3 times better at controlling their cravings and had significantly greater improvements in pain, stress, and positive emotions, even though they were aware of more cravings than those who only received standard methadone treatment and counseling. “Methadone maintenance therapy (MMT) has been an effective form of medication treatment for opioid use disorder,” said Associate Professor Nina Cooperman, a clinical psychologist in the Division of Addiction Psychiatry at Rutgers Robert Wood Johnson Medical School. “However, nearly half of individuals on MMT continue to use opioids during treatment or relapse with six months.” Cooperman said many of those with opioid addictions experience chronic pain, anxiety and depression while on methadone maintenance, which is why mindfulness-based, non-drug interventions are promising treatments. The researchers said mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain. Individuals with an opioid addiction could also be taught to change their negative thoughts and savor pleasant events, which may help them to regulate their emotions and experience more enjoyment. Associate Professor Anna Kline at the Rutgers-Robert Wood Johnson Medical School co-authored the study, which included researchers at the University of Utah. To read the original article click here.

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