A significant portion of individuals who are addicted to opioid painkillers may initiate and maintain abstinence with a brief but intensive outpatient detoxification treatment followed by opioid antagonist therapy using naltrexone.
This is the first in a series of NIDA Notes articles that will follow a team of researchers seeking a medication for methamphetamine addiction. This installment describes the early promise of the compound lobeline and the new directions the team discovered in studying it.
Dr. Kevin M. Gray discusses why it’s the perfect time for discovering new evidence-based treatments for marijuana dependence. In an accompanying podcast, he discusses a clinical trial that examines NAC’s potential as a treatment for marijuana dependence among adults.
Nano-antiretroviral therapy (nano-ART) turns macrophages—one of the very cell types that HIV uses to replicate and spread through the body—into carriers for anti-HIV medications. The approach has the potential to make treatment for HIV easier and more effective.
Clinicians associated with the Veterans Administration looked more favorably upon contingency management after attending training workshops on the use of the intervention. Despite being highly effective at decreasing drug use, contingency management is one of the least used among proven substance abuse treatments.
Two recent studies suggest that genotyping may enable clinicians to base therapies on individual patients’ potential responsiveness to opioid drugs’ therapeutic effects and vulnerability to their harmful effects.
One of NIDA’s goals is to try to understand the individual differences that contribute to whether or not someone who takes a drug will become addicted to it. Dr. Rutter’s research focuses on three types of differences: Environmental, developmental, and genetic and epigenetic.
Intensified screening for HIV among injection drug users receiving opioid agonist therapy could prevent more than twice as many new infections as current screening practice. A recent study based on mathematical modeling found that screening every 6 months instead of annually, and adding viral RNA testing to the currently used HIV antibody testing, could improve both effectiveness and cost-effectiveness.
Active drug use before incarceration was associated with decreased engagement in HIV treatment among HIV-infected jail detainees. The severity of drug dependence correlated with worsening measures of engagement in HIV treatment. The study concludes that evidence-based treatment for drug abuse in jails may result in improved HIV treatment outcomes, which in turn could help slow HIV-transmission rates in the United States.
Microneedles are an innovative technique for delivering medications through the skin, a route that could particularly benefit patients receiving naltrexone therapy for opioid and alcohol dependence. Researchers have found a way to use the transdermal technique to deliver a single treatment of naltrexone that lasts for 7 days.
Study patients with HIV–hepatitis C coinfection progressed to successive degrees of severity of liver fibrosis 9 years sooner than those infected with HCV alone. Further findings from the study suggest that suppressing HIV with antiretroviral medications may slow HCV-related liver fibrosis.
A trial of buprenorphine/naloxone (Bup/Nx) showed no evidence that the medicine was associated with liver damage. The drug gave results similar to those of methadone. The study data indicate that although most patients can be treated safely with either methadone or Bup/Nx without major concern for liver injury, clinicians are advised to continue to monitor the liver health of their patients who are on methadone or Bup/Nx therapy.
More than half of heroin-addicted patients treated with naltrexone via an implanted delivery device maintained abstinence throughout a 6-month clinical trial in Saint Petersburg, Russia. The implant device, which releases a steady dose of naltrexone continuously for 2 months, averted relapse to heroin use three times as effectively as daily oral doses of the medication.
People with cannabis use disorder (CUD) are likely also to have social anxiety disorder (SAD), and comorbid SAD is associated with greater severity of cannabis-related problems. These findings highlight the importance of assessing CUD patients for SAD, as that disorder can be both a contributing cause and a consequence of CUD. Treating both disorders may be a key to helping patients recover from each.
Dr. Marilyn Huestis of NIDA’s Intramural Research Program talks about conducting research on drug effects with human subjects, developing tests to help law enforcement identify drugged drivers, and an assay to help identify children whose prenatal exposure to anti-HIV drugs may put them at risk for adverse developmental outcomes.
A new vaccine hindered the often-abused prescription opioids oxycodone and hydrocodone from entering the brain and suppressed one of the drugs’ signature central nervous system effects. The findings warrant continued development of the vaccine as a potential aid in the treatment of oxycodone and hydrocodone abuse and dependence.
Men benefit more than women from nicotine replacement therapy for smoking cessation because nicotine affects a key neuroreceptor differently in the two sexes, a NIDA-sponsored study suggests. The findings highlight the need for alternative therapies for women smokers, and point to the female hormone progesterone as a potential therapeutic target.
Marijuana-dependent outpatients who were treated with the medication gabapentin in a pilot clinical trial reduced their cannabis use more and reported fewer symptoms of drug withdrawal than patients who received a placebo.
Several factors contribute to treatment professionals’ stress and burnout, including how much influence they feel they have in their organization and their caseload. Surprisingly, a NIDA-supported study found that the link between staff stress and burnout was weaker in programs with higher patient caseloads than those with lower caseloads. In addition, program administrators can help counselors reduce their stress by giving them a voice in organizational policies and procedures.
Nicotine sensitizes the mouse brain to the addictive effects of cocaine, according to recent NIDA-supported research. The results accord with the hypothesis that a person’s initial use of an addictive substance physiologically sensitizes his or her brain to the rewarding and addictive effects of other substances. If the findings carry over to people, then preventing youths from smoking might reduce their vulnerability to cocaine abuse and addiction, and cocaine-dependent individuals might ease their path to recovery by quitting smoking.
Despite the advances in treatment and prevention, roughly 50,000 new HIV infections still occur annually in the Nation. Research, in large part supported by NIDA, has produced a strategy to address this circumstance and break the epidemiological impasse: seek out HIV-infected individuals, particularly those in “hard-to-reach” groups that have minimal contact with the health care system; offer them HIV testing and treatment; and provide support to help them stay in treatment.
NIDA-funded researchers have gathered evidence that brief interventions can help adolescents move away from drug use. In a clinical trial, middle and high school students markedly reduced their substance use following two 60-minute sessions that combined motivational interviewing and cognitive behavioral therapy.
The immune system has an extraordinary ability to recognize compounds foreign to the body and eliminate them. NIDA-sponsored scientists are working to harness this ability to create vaccines that will protect individuals against the psychogenic and addictive effects of abused drugs. This animation shows one of the most promising strategies, which has already yielded partial success in producing effective vaccines against nicotine, cocaine, and other drugs.
NIDA Program Officer Dr. David Thomas speaks about the intertwined problems of pain and prescription opioid abuse, as well as the research supported by NIDA and the National Institutes of Health to address these problems.
New vaccines that aim to promote recovery from cocaine and heroin abuse showed promise in animal testing. Both vaccines induced rats’ immune system to produce high titers of antibodies that inhibit the target drug from reaching the brain. The rats’ behaviors when given access to the target drug indicated that the vaccines reduced the reinforcing effects that, in recovering people, can cause lapses to turn into relapses.
Fewer than 12 percent of adolescents who meet diagnostic criteria for prescription opioid abuse or dependence receive any treatment, according to an analysis of data from the 2005 to 2008 National Survey on Drug Use and Health. The most common reason the adolescents gave for not receiving treatment was their lack of perceived need for it.
Intensive case management was more effective in increasing treatment engagement and reducing alcohol consumption among depressed participants than among those who were not depressed, according to a followup analysis of a substance abuse treatment study involving women on welfare.
Soluble-film preparations of buprenorphine suppressed heroin abusers’ withdrawal symptoms with no serious side effects in a recent clinical trial. They dissolved more rapidly in the mouth than the pill form of the medication, providing faster relief.
NIDA researchers have developed a computer program that motivates and encourages treatment-seeking when an individual is in a primary care physician’s waiting room. Users of the program, called Video Doctor, enter information on a portable device and receive feedback about health risks related to their drug abuse, along with advice, immediately prior to seeing their physician.
Sublingual buprenorphine is a safe and effective alternative to methadone for treating opioid dependence during pregnancy, finds the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, a NIDA-supported clinical trial. Women who received either medication had similar pregnancy and birth outcomes, but infants born to women who received buprenorphine had milder symptoms of neonatal opioid withdrawal.
Dr. J. David Jentsch is the recipient of the 2011 Jacob P. Waletzky Memorial Award for Innovative Research in Drug Addiction and Alcoholism. Dr. Jentsch and colleagues at the University of California, Los Angeles, are studying genetic and neurochemical factors that influence individual differences in inhibitory control.
Dr. Volkow discusses NIDA’s efforts to develop effective antismoking treatments for populations with persistently high rates of smoking, such as people with psychiatric disorders, high school dropouts, and Native Americans.
While viewing images of cigarettes, smokers reported milder cravings when they shifted their focus from the pleasures of smoking to its harmful effects. Brain imaging showed a correlation between the reductions in craving and altered activity levels in regions associated with emotional regulation and reward.
Women with posttraumatic stress disorder (PTSD) who abused drugs responded better to substance abuse treatment after their PTSD symptoms improved, according to a recent study, which also found that reductions in substance abuse did not ease PTSD severity
New research suggests that differences in tobacco consumption reflect, in part, differences in the functional efficacy of a specific type of receptor in a pathway of the brain. In animal studies, nicotinic acetylcholine receptors with the α5 subunit played a key role in producing aversive responses to nicotine, thereby dissuading further consumption of the drug.
Helping smokers deal with financial problems could improve their chances of staying abstinent after receiving treatment, according to a new study. Participants with the most financial strain had the least success in remaining abstinent.
In a new series of studies tracing the molecular events that occur in the brain as memories are formed and preserved, researchers find that certain epigenetic changes may promote vulnerability to relapse.
Individuals with weak signaling in a nicotine-sensitive brain circuit were more vulnerable to nicotine dependence than those with stronger signaling, according to a study conducted while the subjects’ brains were in a resting state. A second resting-state study finds that the same circuit appears to mediate dependence associated with a genetic risk factor for smoking.
New studies show that microRNAs, snippets of RNA implicated in a wide variety of biological processes, are involved in promoting and inhibiting cocaine addiction. The findings could pave a new path for the development of anti-addiction therapies.
Describes a study revealing that HIV-infected prisoners in Texas often experience an interruption in treatment following their release and that assistance in filling out paperwork can reduce these interruptions.
Examines results from a randomized clinical trial which found that treatment with a nicotine patch and nicotine lozenge together produced the greatest benefits in helping people quit smoking and remain abstinent.
Reports findings from a survey that revealed that although substance abuse is prevalent in jails and prisons, many correctional facilities do not offer detoxification services or therapies to aid in maintaining abstinence.
Reports on the results of a clinical trial that tested the effectiveness of a cocaine vaccine designed as a therapy for cocaine abuse and plans underway for a new study of 300 patients to confirm these results.
Describes findings from two randomized clinical trials showing that treatment with multidimensional family therapy resulted in fewer drug-related problems than treatment with cognitive behavior therapy.
Presents a summary of a study that followed individuals who entered mental health crisis or substance abuse detoxification residential centers in San Francisco and the types of treatment they received.
Highlights a project in which nine research centers collaborate with criminal justice partners to test science-based tools for integrating drug abuse treatment in prisons and probation and parole programs.
Describes a series of experiments that have added to evidence that a brain enzyme controls key memory processes that link drug experiences, the surroundings in which they take place, and the urge to repeat them.