Month: August 2018

Opioid crisis breakthrough: Non-addictive painkiller found effective

http://bit.ly/2PpCESF

Scientists have tested a non-addictive painkiller in primates and found it to be safe and effective. The fact that the compound was successful in a species so closely related to humans strengthens the findings, which could help solve the opioid public health crisis.

AT-121 was designed with a dual purpose in mind: to block the addictive action of opioids and to relieve chronic pain at the same time.

To this end, Prof. Ko and colleagues developed the drug so that it would simultaneously have an action on the “mu” opioid receptor, which makes opioids effective in relieving pain, and the “nociceptin” receptor, which inhibits the addictive effect of opioids.

Some of the current opioids, such as fentanyl and oxycodone, only act on the mu opioid receptor, which is the main reason that they become addictive and have a wide range of side effects.

Prof. Ko explains, “We developed AT-121 that combines both activities in an appropriate balance in one single molecule, which we think is a better pharmaceutical strategy than to have two drugs to be used in combination.”

In their tests, the researchers revealed that the newly designed compound had a “morphine-like” pain-relieving effect, but it only needed the 100th part of a typical morphine dose to achieve this effect.

Integrating Care for Kids: A New Model and a Promising Opportunity

http://bit.ly/2on2HOC

Last week, the Centers for Medicare and Medicaid Services (CMS) announced its investment in a new grant program to test innovative approaches to improving children’s health. The program, Integrated Care for Kids (InCK), will provide funding for up to eight states to design and implement one or more child-focused models of care. These projects, which will last seven years, will aim to improve child health outcomes, reduce avoidable inpatient stays and out-of-home placements and create sustainable alternative payment models.

CMS specifically intends these projects to focus on addressing children’s behavioral health needs including opioid or other substance use issues. Young people are in a critical window of vulnerability to substance misuse and addiction. This program will help state Medicaid programs expand substance use prevention and treatment, keeping kids on a healthy path to avoid the destructive consequences of drug and alcohol problems.

Up to this point, value-based payment efforts have generally focused on groups who experience higher health care costs. Since children are typically healthy, there has not been much attention given to children’s needs. Designing alternative payment models for children has also proved challenging because the cost savings often come many years later and may show up as savings in other sectors. However, we know that children are not little adults. Therefore, it is important to create health systems that align with their particular social, emotional, physical and mental health needs. Providing states with the resources to design and implement a payment and delivery system that integrates the work of providers across behavioral health, physical health and other child serving agencies will ensure that the particular needs of children and families are met.

Since the focus of this program will be on children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), it is also a tremendous opportunity to influence the social determinants of health and address health equity. These alternative payment model pilots will serve many children of color. Of the nearly 46 million children enrolled in Medicaid and CHIP, approximately two-thirds of them are children of color. Data show children of color experience more traumatic events than their white peers. These adverse childhood experiences (ACEs) influence brain development and can have lifelong impacts on physical, mental and behavioral health. This new approach means states will be able to prioritize listening to and acting on the expertise of children and families who may have had negative experiences with health and social service systems due to racism or other factors. Developing alternative payment models with the goal of ameliorating these challenges will help ensure that all children and families thrive.

Online Education Is a Disability Rights Issue

http://bit.ly/2PoA4MO

It is time to destigmatize and expand online learning opportunities for college students with disabilities, Brittany Collins argues.

How could I continue to learn and grow in an academic environment if my body did not allow me to return to campus? How could I forge a path to self-sufficiency? As an education major, could I still contribute to the field even if my standing at the front of a classroom was precluded?

Though isolated, I knew that I was not alone in my predicament. One in 5 Americans lives with a disability, and one in 10 has a severe condition. As an American studies professor once told me and a lecture hall of classmates, we are fragile; despite what mainstream culture leads us to believe, young people are no exception — even if our prefrontal cortices tell us otherwise.

The Americans With Disabilities Act of 1990 added breadth to the educational opportunities afforded students with disabilities: 2007-08 and 2011-12 studies conducted by the National Center for Education Statistics show that 11 percent of college students reported having a disabling condition, which is not an insignificant fraction of the general student body.

Higher education therefore presents a catch-22 for students with disabilities. Enrolling may seem tenuous, physically strenuous (if at all possible) and even irresponsible given that many people with disabilities are poor or low income, and a pile of student loans adds burden to an already tilted probability of independence.

The National Council on Disability interviewed students with disabilities and found that the majority of subjects “were worried about student loans because of their disability-related needs … will not take out loans because of their concerns about being able to work and repay them … [or] were concerned that they might not be able to work enough hours to repay their student loans, but did not specifically state that they would not take out loans in the future.”

So what are the solutions? While many colleges have part-time programs, online courses or blended learning options, my liberal arts campus was not one of them. In 2012, 89 percent of public institutions offered online courses, compared to just 60 percent of private. Far fewer offer online undergraduate programs, and this poses a complicated problem: Is it reasonable for students whose disabilities impede campus attendance to request technological accommodations that would catalyze their remote participation in an otherwise in-person program? Must their educational opportunities be narrowed to those available at online schools?

Brain scans show how cannabis extract may help people with psychosis

This is about the extract CBD, NOT THC or the whole plant….

http://bit.ly/2onvqD4

Cannabidiol reduces the brain activity linked to hallucinations, delusions and other forms of psychosis, research has found.

Brain scans have revealed for the first time how a substance found in cannabis plants may help people with psychotic disorders by dampening down abnormal brain activity that arises in the patients.

A single dose of cannabidiol, an non-intoxicating extract of the plant, reduced unusual patterns of neural behaviour linked to hallucinations, delusions, and other symptoms of psychosis, researchers found.

The impact of the substance has raised hopes that medical preparations of pure cannabidiol, or new drugs based on the compound, may be turned into effective treatments for young people who develop psychosis but do not respond to existing therapies.

While high strength cannabis is suspected of raising the risk of mental health problems in some frequent cannabis users, cannabidiol or CBD appears to have opposite, antipsychotic properties. In illicit cannabis, there is too little CBD to have much beneficial effect, but researchers have long wondered whether doses of pure CBD may help to protect against psychosis.

“We knew from previous studies that CBD had antipsychotic effects, but we didn’t know how it worked,” said Bhattacharyya.

 

What a Lifetime of Adderall Does to Your Brain

It seems that every generation has a destructive relationship with some stimulant. From benzedrine through Preludin, meth, and Adderall, there is always some stimulant drug (starting out as prescribed) that produces the same outcomes……

http://bit.ly/2wwfYYT

Millennials were the first generation of Americans to be habitually prescribed stimulants like Adderall to treat ADHD. They were also the first generation of Americans to habitually abuse these prescribed stimulants as “study drugs” well into high school and college (a 2012 review found that the nonmedical use of these pills represent the second most prevalent form of illicit drug use in college, after weed).

Many of these millennials have since become addicted to Adderall — prescribed or not — and their drug habits are accompanying them into the workplace: The number of American workers who tested positive for amphetamines increased by 44 percent between 2011 and 2015.

This widespread addiction isn’t exactly surprising when you consider how Adderall interacts with the brain. Journalist Casey Schwartz details this process in “Generation Adderall,” a piece for the New York Times Magazine:

Amphetamines unleash dopamine along with norepinephrine, which rush through the brain’s synapses and increase levels of arousal, attention, vigilance and motivation. Dopamine, in fact, tends to feature in every experience that feels especially great, be it having sex or eating chocolate cake. It’s for this reason that dopamine is so heavily implicated in current models of addiction. As a person begins to overuse a substance, the brain — which craves homeostasis and fights for it — tries to compensate for all the extra dopamine by stripping out its own dopamine receptors. With the reduction of dopamine receptors, the person needs more and more of her favored substance to produce the euphoria it once offered her.

The end result is full-blown addiction, akin to a dependence on crystal meth, and attempting to escape its hold will, without a doubt, result in intense withdrawal symptoms. “With Adderall, withdrawal can mimic the symptoms of severe depression, cognitive slowing, low energy and lethargy,” explains Kimberly Dennis, CEO and medical director of SunCloud Health, a private outpatient treatment center. “That’s the exact opposite of what a person taking Adderall to enhance work performance wants.”

Even those lucky enough to escape the drug’s addictive grip are sure to experience bumps along the road. Schwartz, for instance, ended up in the emergency room after experiencing an amphetamine-induced panic attack. “My life was no longer my own,” she writes in her New York Times Magazine piece. “I had long been telling myself that by taking Adderall, I was exerting total control over my fallible self, but in truth, it was the opposite: The Adderall made my life unpredictable, blowing black storm systems over my horizon with no warning at all.”

Despite the very real warning signs — more than 116,000 people were admitted to rehab for an addiction to amphetamines like Adderall in 2012 — there’s still not nearly enough research out there on exactly how extended Adderall use affects the brain. The reason for that, though, is valid: Because millennials were the first generation to be routinely prescribed Adderall, we’ve yet to see what happens to those who rely on the drug when they get old.

This isn’t to say that you should freak out if you briefly experimented with Adderall to crank out a 30-page essay overnight — or to keep the party going. “At small, recreational doses (20 to 40 milligrams), you’ll see some biological changes in the brain and some psychological changes, but they won’t be permanent,” explains Timothy Fong, director of UCLA’s Fellowship in Addiction Psychiatry. “It’s when people take massive amounts — not orally, but by snorting it or mainlining it [for a stronger effect] — that it becomes really neurotoxic.”

Wheelchair Breakdowns May Be Linked to Health Consequences for People with Spinal Cord Injuries

http://bit.ly/2PhpdEk

A spinal cord injury (SCI) consists of damage anywhere along the spinal cord from an accident or other trauma, oftentimes causing weakness or paralysis. Many people with SCI use wheelchairs to get around. Along with mobility, wheelchairs offer physical support for a person’s trunk and limbs. A properly functioning wheelchair can help prevent pain, pressure injuries (also called pressure sores), and other complications after an SCI. However, if their wheelchairs break down, people with SCI may have difficulty getting around or caring for their wellness needs. Previous research has found that up to half of wheelchair users with SCI experience such breakdowns at least once in a six-month period, with potentially significant consequences such as being stranded away from home, missing important appointments, or being injured. In a recent NIDILRR-funded study, researchers looked at the connections between wheelchair breakdowns and health issues for people with SCI. They wanted to find out if people who had a recent wheelchair breakdown had worse health, worse pain, or more hospitalizations than people who had not had a recent wheelchair breakdown.

Researchers at the University of Pittsburgh Model Center on Spinal Cord Injury reviewed 610 responses to a survey of people with SCI who enrolled in a longitudinal data collection at nine SCI Model Systems centers. The participants were over 16 years old (with an average age of 44 years old), had their SCI for at least a year, and all used a manual or powered wheelchair for at least 40 hours a week.

On the survey, the participants were asked if they had experienced their wheelchair breaking down at least once during the last six months. If they had, they were then asked whether or not the wheelchair breakdown had caused an “immediate consequence” such as being stranded; being injured; or missing a medical appointment, work, or school. The participants were also asked to rate their overall health status on a scale ranging from excellent to poor; indicate how much pain they experienced over the last month on a ten-point scale; and indicate whether or not they had been hospitalized in the last 12 months as well as whether the hospitalization was for a pressure injury or for another reason. In addition, participants were asked whether had access to a working back-up wheelchair.

The researchers found that 58% of the participants had their wheelchair break down at least once in the last 6 months, and 18% of the participants experienced an immediate consequence resulting from their wheelchair breaking down. The most common consequence was being stranded, followed by missing a medical appointment, missing school or work, and being injured. Compared to the participants whose wheelchairs did not break down, the participants who experienced a breakdown with immediate consequences reported worse overall health, more severe pain, and were more likely to have been hospitalized for pressure injuries. The participants whose wheelchairs broke down without immediate consequences had no more health issues than the participants whose wheelchairs did not break down. About 43% of the respondents reported having a back-up wheelchair., However the researchers found that having a working back-up wheelchair did not reduce the likelihood of negative health following one of these breakdowns.

A Third of Heavy Pot Users Suffer Severe Nausea — and They’ve All Landed on the Same Weird Solution

http://bit.ly/2omoBle

Marijuana is developing quite the reputation for relieving pain without the negative aspects of opioids and other medications, such as addiction or death by overdose. But that doesn’t mean it’s perfect. A New York Times report last week brings to light one particularly painful and debilitating set of consequences associated too much pot use.

Cannabinoid hyperemesis syndrome (CHS) is a condition where heavy marijuana users (those who smoke 20 times a month or more) are frequently wracked with bouts of intense abdominal pain, along with severe nausea and vomiting. And the vast majority of people who experience these symptoms all mysteriously arrive at the same solution.

CHS is still poorly understood, but researchers are making strides in identifying and characterizing its origins. A new study by Joseph Habboushe, an emergency medicine professor at New York University Langone/Bellevue Medical Center, suggests that perhaps one-third of the 8.3 million heavy users in the U.S. experience CHS. And there’s one thing almost all of them have in common: Their incessant need for hot showers.

In a separate study, Cecilia Sorensen, a physician at the University of Colorado Hospital at the Anschutz medical campus in Aurora, and her colleagues found that about 97.5 percent of the participants in their study used hot showers to alleviate CHS symptoms. “As a clinician in the emergency room, when I have a patient who has CHS, I ask them if they take a lot of hot showers, and the reaction is instantly like, ‘how did you know?!’ It’s become a useful diagnostic for CHS,” she says.

Chances are good you love a hot shower too. They can be soothing, immeasurably comfortable, and a great way to urge your muscles to relax. But when it comes to CHS, hot showers provide a much more specific and intense effect: a nearly complete reduction of bodily pain and nausea. Many patients report those symptoms quickly coming back once the shower is over or the hot water goes out.

Lawsuit: Stanford Pressures Students Struggling With Mental Health to Leave Campus

https://thebea.st/2ooUQAi

A class-action lawsuit accuses Stanford University of “discriminating” against students who have mental-health issues by “coercing them into taking leaves of absence, rather than trying to meet their needs on campus,” The New York Times reports.

The suit, filed by a legal center called Disability Rights Advocates, claims that students struggling with mental-health problems were “effectively banished” from the university once they were placed on leave, and also “stripped of their privacy and autonomy.” The leave process is allegedly abrupt, as students are “required to immediately withdraw from all classes, programs and housing.”

In order to return to Stanford, students allegedly had to write statements “accepting blame” for their behavior during their mental-health struggles. Students at Stanford and other schools told the newspaper that they approached their school’s counseling centers, only to find school officials wanting to boot them off campus. Harrison Fowler, a Stanford student who took a yearlong leave of absence at the university’s urging, says that he felt “blamed” for his own behavior by Stanford. “I don’t want people to be scared to reach out for help,” he told the Times.

Cracking the Sugar Code: Why the ‘Glycome’ Is the Next Big Thing in Health and Medicine

http://bit.ly/2wzSqCK

You’ve heard of the genome, and possibly the proteome – all the proteins in the human body. But have you heard about the glycome – the collection of sugars – that may hold the key to diagnosing disease?

When you think of sugar, you probably think of the sweet, white, crystalline table sugar that you use to make cookies or sweeten your coffee. But did you know that within our body, simple sugar molecules can be connected together to create powerful structures that have recently been found to be linked to health problems, including cancer, aging, and autoimmune diseases?

These long sugar chains that cover each of our cells are called glycans, and according to the National Academy of Sciences, creating a map of their location and structure will usher us into a new era of modern medicine. This is because the human glycome – the entire collection of sugars within our body – houses yet-to-be-discovered glycans with the potential to aid physicians in diagnosing and treating their patients.

 

Help Us Investigate PTSD in First Responders

http://bit.ly/2ohJlKV

ProPublica is teaming up with Orlando public radio station WMFE to examine the toll PTSD has taken on first responders and their relatives. Tell us your story.

ProPublica and WMFE are investigating post-traumatic stress disorder and how it affects first responders and their families.

Whether it’s called shell shock or combat fatigue, there has long been a recognized link between war and the symptoms we now call PTSD, such as reliving an event through flashbacks and nightmares. That broad recognition often isn’t there for police officers and firefighters — even as more mass shootings bring the scenes of war to U.S. soil.

Psychiatrists now recognize that continued exposure to so-called bad calls over the course of a career can have a stacking effect, leading to PTSD. PTSD rates in first responders haven’t been studied at a national scale, but smaller studies of firefighters have found it to be anywhere between 6.5 percent and 37 percent. We know PTSD not only affects the first responder, but also those around them.

And PTSD can lead to suicide. By one survey, one in 15 paramedics and EMTs has attempted suicide. That rate is more than ten times higher than for the general population.

We want to understand the magnitude and the experiences of PTSD in first responders — not only how many are out there, responding to calls and struggling in silence, but the specifics of what they are going through.

It’s why we’ve created a questionnaire for first responders and the people closest to them. Your stories will help fuel our reporting and broaden our understanding of the trauma in a group that feels it.

We recognize that these stories are sensitive and hard to talk about, but we are listening — and we will do everything in our power to protect your privacy. Our reporting is only as strong as the people who come forward to share their stories.