Author: Shernide Delva
In the past, we’ve talked about the potential of opioid vaccines. These vaccines could have a major impact on lowering a number of opioid overdose deaths. They could completely shift the direction of how we treat opioid addiction. However, is the future of opioids imminent or far, far away?
Sadly, it will be a long time before we see opioid vaccines available for widespread use. Experts all agree that although the future of opioid vaccines looks bright, the process of getting a drug into the market is a lengthy one and we should not hold our breath just yet.
Recently, Health and Human Services Secretary Tom Price mentioned opioid vaccines as an exciting new development in the war against opioid abuse.
“One of the exciting things that they’re actually working on is a vaccine for addiction, which is incredibly exciting,” Price said during a briefing about the drug epidemic.
However, experts say it won’t be made public for years… if ever.
The process of a drug going from the research phase to the production phase is a long, tedious process. Opioid addiction vaccines have not even begun human trials yet. Researchers would have to put drugs through phase one, two and three trials before submitting them for approval by the Food and Drug Administration (FDA), given that the trials are successful.
“He may be a physician, but he’s not terribly well-informed about addictions,” said Dr. Thomas R. Kosten, a psychiatry professor at the Baylor College of Medicine with a concentration in addiction vaccines. “I can’t imagine the vaccine would be on the market before the Trump administration is over.”
Dr. Kosten knows all about vaccines. He worked on cocaine vaccines for 16 years before deciding that it “just didn’t work well enough” to continue. Today, he is working on a vaccine for fentanyl, an opioid painkiller up to 100 times stronger than morphine. Fentanyl has been a major culprit for overdose deaths in the current opioid epidemic.
Those who previously used painkillers turn to heroin due to the lower price and easier access. Unfortunately, often heroin is not just heroin and instead is laced with powerful painkillers like fentanyl which make a user much more susceptible to an overdose.
Dr. Kosten hopes his work on the vaccine will pan out, but he wants to ensure people are not holding their breath. These things take time.
“There are no opiate vaccines that have been in people at this point,” said Dr. Kosten.
Even if the vaccine passes trials and goes into full-scale production, it would only be used therapeutically, not as a preventative measure.
“The purpose is not to “mass-immunize a whole bunch of kids,” Dr. Kosten said. “That’s not at all what they’re designed for.”
For now, the vaccine is proving to be effective in animal testing. However, this is not necessarily good news.
“Sometimes, the translation from animals is not necessarily the same in humans. So we have to do the human studies,” said Dr. Ivan Montoya of NIDA’s Division of Therapeutics and Medical Consequences.
The goal of the vaccine is to allow the body’s own immune system to combat opioids before they can reach the brain and take effect.
“We don’t have to modify the brain to produce the effect,” said Dr. Montoya. “You take advantage of your own immune system and prevent access of the drug to the brain.”
In the future, Dr. Montoya hopes to come up with a vaccine that can block the effects of a wide range of opioids including fentanyl, heroin, and OxyContin.
While the prospect of opioid vaccines sounds promising, we are still far away from this becoming a reality. Therefore, stating vaccines as an exciting solution to the opioid epidemic is a bit of a stretch for now. Instead, the focus should be placed on increasing access to treatment. With the right program, recovery is possible. If you are struggling with substance abuse, call now. Do not wait.
CALL NOW 1-800-951-6135
Author: Shernide Delva
These are just a few of the incentives doctors have received from prescription opioid companies. Did these goodies get you your last opioid prescription?
Could incentives be responsible for our current opioid epidemic?
That’s exactly what researchers set out to understand.
A recent report confirmed what many have suspected: doctors are receiving incentives from major opioid makers. In fact, one out of every 12 U.S doctors gets money, lunch or something else of value from companies that make opioid drugs, the study concluded.
Furthermore, companies are spending more time and effort marketing opioids to doctors than they are other less addictive painkillers. These finding will help understand why doctors have played such a major role in the opioid addiction crisis.
“A large proportion of physicians received payments — one in 12 physicians overall,” said Dr. Scott Hadland of the Boston Medical Center. “Tens of millions of dollars were transferred for marketing purposes for opioids.”
Dr. Hadland and colleagues went through databases from the Centers for Medicare and Medicaid Services, the federal government office that oversees public health insurance.
The 2010 Affordable Care Act includes the Physicians Payments Sunshine Act. This act required medical product makers to report any offerings or goodies made to doctors or to teaching hospitals. However, incentives are often disguised as something else.
“In some cases, they are money provided directly to physicians — for example, the speaking fees, the consultant fees and the honoraria. In other cases it is reimbursement for things like travel,” Hadland said.
On average, doctors get a single “payment,” usually a mean worth of $15 about once a year. Still, there are a select few doctors that are reaping the most benefits.
“The top 1 percent of physicians (681 of them) received 82.5 percent of total payments in dollars,” the team wrote in their report, published in the American Journal of Public Health.
These incentives could influence doctors to prescribe opioids to their patients:
“One of the main drivers of the epidemic has been the vast overprescribing of prescription pain medications,” the study notes.
Between 2013 and 2015, the team found 375,266 payments totaling 26 million distributed to more than 68,000 doctors.
While larger fees mostly accounted for speaker fees, more leisurely incentives like food and drink accounted for 94 percent of the payments.
“I do think the practice is exceedingly common. Increasingly, medical schools are restricting the ability of pharma companies to come to speak to medical students and even faculty,” Hadland said.
With all this said, do small incentives really make a difference? After all, can a doctor really be bought for the price of a boxed lunch?
The research indicates that, yes, these little goodies do influence prescribing. Last year, a study revealed that physicians who accepted even one meal by a drug company were more likely to prescribe a name-brand drug to patients later.
This is not the first time investigations were conducted on possible incentives. After earlier controversies and studies, the Pharmaceutical Research and Manufacturers of America issued a voluntary code of conduct to curb the once widespread practice of handing out free mugs, prescription pads, and other swag covered in drug brand names.
Some cities and states especially hit by the opioid abuse epidemic have even sued drug makers saying their practices have helped fuel the problem. The CDC states doctors have contributed to the addiction crisis by prescribing opioids to too many patients. These prescriptions are often prescribed at high doses for too long which only increases the vulnerability to addiction.
The result is deadly.
There were more than 30,000 fatalities in the United States in 2015, the federal government said.
“I think that first and foremost we have known that one of the main drivers of the epidemic has been the vast overprescribing of prescription pain medications,” said Michael Botticelli, former director of the White House Office of National Drug Control Policy, and now executive director of the Grayken Center for Addiction Medicine at the Boston Medical Center.
According to Botticelli, the answer is independent education, free of the need to promote a specific product.
“At the federal and state level (we may need to) move toward mandatory prescriber education to counteract industry’s influence over prescribing behavior,” he said. “Clearly, guidelines are not enough.”
For a long time, prescribing opioids was one of the first responses to pain management. Now other alternatives are being promoted such as pain management devices and holistic alternatives.
Botticelli agrees that while pain is a major problem, the answer is not more opioids.
“Yes, we want to make sure people’s pain is appropriately treated, but we know that longer and higher doses have significantly added to the addiction problem that we have in the United States,” he continued.
What are your thoughts? Did you know about these incentives? More studies are coming out revealing the back story to what led to the prescription opioid epidemic.
Opioid addiction has become a public health crisis. Now, more than ever is the time to seek treatment. Recovery is possible. You do not have to feel out of control. There is a solution. If you are struggling with substance abuse, call now. Do not wait.
CALL NOW 1-800-951-6135
Author: Shernide Delva
Each year, more than 300 million people are affected by depression. Depression is a debilitating illness that is difficult to treat.
What if there was one gene that played a key role in depression? Furthermore, what if that gene could be identified and even manipulated to actually treat depression?
Shockingly, this could all be a possibility. Researchers have discovered a gene that may play a central role in depression. This gene either protects us from stress or triggers a downward spiral depending on its level of activity.
The study was conducted by researchers at the University of Maryland School of Medicine (UM SOM). It was the first to pinpoint in detail how one particular gene, known as Slc6a15, is a key role in depression. The study found the same link in both animals and humans.
“This study really shines a light on how levels of this gene in these neurons affects mood,” said the senior author of the study, Mary Kay Lobo, an assistant professor in the Department of Anatomy and Neurobiology.
“It suggests that people with altered levels of this gene in certain brain regions may have a much higher risk for depression and other emotional disorders related to stress.”
Potential Treatment Solution?
A study like this could help with treating depression in the future, and that help is desperately needed.
Nearly 800,000 people die annually from suicide. It is the second leading cause of death among people between the ages of 15 to 29. Beyond that, depression destroys the quality of life for tens of millions of patients, and their families suffer too. Although environmental factors play a significant role in many cases of depression, genetics are equally as important.
This is not the first time this gene was studied. Back in 2006, Dr. Lobo and her colleagues found that the Slc6a15 gene was common in specific neurons in the brain. They recently demonstrated that these neurons were important in depression.
Connection to Anhedonia
Her lab decided to investigate the specific role these neurons have in depression. In the latest study, she and her team focused on a particular area of the brain called the nucleus accumbens. This region is crucial in the brain’s “reward circuit.”
When you eat a delicious meal or participate in any kind of enjoyable experience, neurons in the nucleus accumbens are activated letting you know the experience is enjoyable. When a person is depressed, it ‘s hard to experience any kind of enjoyment, a condition known as anhedonia.
Researchers discovered subset neurons in the nucleus accumbens called D2 neurons. These neurons respond to the neurotransmitter dopamine, which plays a central role in the reward circuit.
Mainly, these subset neurons responded to feel good chemicals like dopamine which is lacking in those with depression. Next, they studied mice susceptible to depression. These mice tended to withdraw from activities and exhibit behavior indicating depression such as social withdrawal and lack of interest in the food they would normally enjoy.
Dr. Lobo found that when the mice were subject to social stress, the levels of the Slc6a15 gene in the D2 neurons of the nucleus accumbens was noticeably reduced. The researchers also studied mice in which the gene had been reduced in D2 neurons. When those mice were subjected to stress, they also exhibited signs of depression. Furthermore, when researchers increased the levels of Slc6a15 levels in D2 neurons, the mice showed a resilient response to stress.
So what does this mean?
Next, Dr. Lobo looked at brains of humans who had a history of major depression and who had committed suicide. In the same region of the brain as the mice, the gene Slc6a15 was reduced. This indicates that the link between gene and behavior is found in both humans and mice.
In the future, manipulating these genes could help improve depression. While it is still unclear how Slc6a15 operates in the brain, Dr. Lobo states it may work by altering neurotransmitter levels in the brain.
This research could lead to therapies that focus specifically on this particular gene to treat depression. If you are struggling with substance abuse or mental illness, call now. Do not wait.
CALL NOW 1-800-951-6135
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Author: Shernide Delva
If you thought all the attention surrounding the opioid epidemic would result in immediate progress, think again.
According to experts, things are going to get a lot worse before they get better.
But just how bad will it get?
Leading public experts agree the epidemic of people dying from opioids could reach up to a half million over the next decade.
Experts at ten universities were asked to project the death toll from opioid overdoses over the next decade. If the worst-case scenario plays out, by 2027, we could be losing 250 people every day to heroin/painkillers in the United States. Right now, that number is closer to 100 deaths per day.
Even scarier, substances like fentanyl and carfentanil, which are many times stronger than heroin, continue to drive up the death toll.
Recent statistics from the Centers for Disease Control and Prevention (CDC) estimate that in 2015, at least 33,000 people died from a fatal opioid overdose. Nearly half of those deaths involved prescription opioids like OxyContin or Percocet.
Still, there is hope that the death toll won’t continue to rise as fast as it currently is. In the best case scenario, STAT predicts 21,300 opioid deaths in 2027 which is lower than 2015 numbers. However, getting to this point will require major investments in evidence-based treatment.
Regardless, all experts agree on one fact: the opioid epidemic will get worse over the next decade before any improvement occurs.
Here are the 10 Opioid Epidemic Scenarios Projected by 2027
The worst scenario: In this scenario, the death toll projection for 2027 is 93,613, an 183% increase from 2015.
In this scenario, the drug overdose total will continue to climb at a steady rate as they have for decades. This scenario assumes that opioid deaths will continue to make up roughly the same percentage of all drug deaths.
In this scenario, the death toll projection for 2027 is 70,239 opioid deaths. This change would be an 112% increase since 2015.
This scenario assumes that opioid use climbs for the foreseeable future, but it takes into consideration the potential progress from reducing opioid prescriptions and other interventions.
In this scenario, the forecast for 2027 is 56,118 opioid deaths. This change would be a 70% jump since 2015.
This scenario assumes that total opioid deaths will rise slightly because of increasing fatal heroin and fentanyl overdoses. The influx of fentanyl and heroin will offset any improvement in prescription opioid abuse.
In this scenario, the opioid deaths forecast for 2027 is 46,740. This would be a 41% increase since 2015.
This scenario assumes that the death toll will increase due to fentanyl and lack of naloxone access. The decline of deaths would occur due to fewer doctors overprescribing opioids due to increase awareness.
In this scenario, the death forecast for 2027 is 45,000. This would be a 36% increase since 2015.
This scenario assumes an increase due to fentanyl use and a reduction in prescription opioid abuse. After several years, this scenario assumes that doctors will begin to prescribe painkillers more responsibly.
In this scenario, the opioid death forecast for 2027 is 44,843. This forecasted change would be a 36% increase since 2015.
This scenario assumes a sharp increase in deaths for the first few years before the effects of interventions and funding through the 21st Century Cures Act kicks into gear, driving the numbers down.
In this scenario, opioid deaths for 2027 is 40,652. This would be a 23% increase since 2015.
This scenario assumes opioid deaths will increase until a combination of intervention strategies like increase naloxone access, decreased prescription opioids, and increased treatment access lower fatal overdoses.
In this scenario, opioid deaths for 2027 is 40,000. This change would be a 21% increase since 2015.
This scenario assumes that heroin laced with synthetic opioids will cause opioid deaths to rise for several years. This rise will peak and then later decline as drug users either fatally overdose or seek treatment.
In this scenario, the death forecast for 2027 is 25,000. This is a 24% reduction since 2015.
This scenario assumes heroin laced with synthetic opioids will result in increased fatal overdoses for several years. Only after this increase will numbers start to decline, as increased naloxone access, addiction treatment, and more supervised injection sites reduce the numbers significantly, resulting in an overall decrease.
– The best scenario: In this scenario, the death forecast for 2027 is 21,300. This is a 36% reduction since 2015.
This scenario assumes that doctors will prescribe fewer opioids, and states will embrace prescription drug monitoring programs. Insurers will begin to enact reforms to increase treatment access.
Overall, all scenarios projected by experts agree that the opioid epidemic will get worse before it gets better if it gets better at all.
The experts agree that opioid deaths won’t begin to slow down until at least 2020. It takes time for governmental efforts to kick in and for education and public awareness to result in positive change.
“It took us about 30 years to get into this mess,” said Robert Valuck, a professor at the University of Colorado-Denver’s School of Pharmacy and Pharmaceutical Sciences. “I don’t think we’re going to get out of it in two or three.”
The opioid epidemic costs the US economy nearly $80 billion annually, according to federal officials. STAT notes that the US already spends about $36billion on addiction treatment, yet only 10% of the estimated 2.2 million Americans with opioid use disorder ever seek help.
This epidemic is not going off the radar anytime soon. Plenty of people are still deep into their addiction and need treatment immediately. If this sounds like you or someone you know, please call now. We want to help.
CALL NOW 1-800-951-6135
Author: Shernide Delva
Chronic pain can be extremely difficult to manage. Pain management involves a variety of treatment options, but one area that desperately needs attention is the psychological impact of chronic pain. According to researchers, about half of adults with chronic pain also experience anxiety or mood disorders like depression.
The findings, published online in the Journal of Affective Disorders, highlight the need to offer treatment and resources to those struggling with the psychological impact of chronic pain.
“The dual burden of chronic physical conditions and mood and anxiety disorders is a significant and growing problem,” said Silvia Martins, MD, Ph.D., associate professor of Epidemiology at the Mailman School of Public Health, and senior author.
The research examined data to analyze the associations between mood and anxiety disorder and self-reported chronic physical conditions. 5,037 participants in São Paulo, Brazil participated in the interview process.
Among individuals with mood disorders, chronic pain was reported by 50 percent, followed by respiratory disease at 33 percent, cardiovascular disease at 10 percent, arthritis by 9 percent, and diabetes by 7 percent.
Anxiety disorders were also common among those with chronic pain reported at 45 percent, and respiratory at 30 percent, as well as arthritis and cardiovascular disease, each 11 percent.
“These results shed new light on the public health impact of the dual burden of physical and mental illness,” said Dr. Martins. “Chronic disease coupled with a psychiatric disorder is a pressing issue that health providers should consider when designing preventive interventions and treatment services — especially the heavy mental health burden experienced by those with two or more chronic diseases.”
Chronic Pain and Painkiller Addiction
One common treatment for chronic pain is the use of prescription painkillers. Opioids like Vicodin, OxyContin, and Percocet affect specific parts of the brain that reduce the perception of pain. However, along with reducing the perception of pain, these medications also release feel-good chemicals in the brain, often leading to dependence.
With this study, it is clear why chronic pain sufferers are susceptible to opioid dependence due to a variety of factors including the need for feel-good chemicals like dopamine. Chemicals like dopamine and serotonin are lacking in those with depression and anxiety.
Many patients who take prescription painkillers do so without forming any dependence. In some, opioid use generates negative side effects such as nausea, making them more unwilling to use the drug’s long-term. Still, some individuals are so desperate for pain relief, that they take larger doses than prescribed more frequently. Not long after, a full-blown addiction develops.
It is important to note that there is no way to know whether a prescription painkiller user will develop an addiction to opioids. However, factors like having a family history of addiction, struggling with mood disorders such as depression or anxiety, or experiencing a past trauma, such as physical or sexual abuse all increase the risk. Those who have struggled with previous addiction are at a higher risk as well.
Another dangerous aspect of opioid addiction is that it often leads to heroin use. Health officials confirm that this is not uncommon. Because painkillers are more difficult to obtain and more expensive, many users turn to using heroin. Heroin is in a similar drug classification as opioids and is easy to obtain for cheap on the street.
Overall, this study says a lot about the way mental disorders and addiction often go hand in hand. That’s why so many treatment centers offer a dual diagnosis program. Therefore, if you struggle with mental illness, addiction or both, please call now. We want to help.
CALL NOW 1-800-951-6135