Helpful or Harmful? The Therapeutic Potential of Medications with Varying Degrees of Abuse Liability in the Treatment of Substance Use Disorders

Journal: Current Addiction Reports, 2022, doi: 10.1007/s40429-022-00432-9

Authors: Bradford Martins, Will Rutland, Joao P. De Aquino, Benjamin L. Kazer, Melissa Funaro, Marc N. Potenza & Gustavo A. Angarita


Purpose of Review: This review summarizes recent clinical trial research on pharmacological treatments for substance use disorders, with a specific focus on agents with potential abuse liability.

Recent Findings: Pharmacological treatments for substance use disorders may include gabapentinoids, baclofen, modafinil, ketamine, cannabinoids, gamma-hydroxybutyrate, and psychedelics. Gabapentinoids may decrease negative subjective effects of withdrawal in alcohol and cannabis use disorders. Cannabinoids similarly appear to decrease use and withdrawal symptoms in cannabis use disorder, while research shows stimulant medications may reduce cravings and increase abstinence in cocaine use disorder. Ketamine and psychedelics may help treat multiple substance use disorders. Ketamine may reduce withdrawal symptoms, promote abstinence, and diminish cravings in alcohol and cocaine use disorders and psychedelics may promote remission, decrease use, and reduce cravings in alcohol and opioid use disorders.

Summary: Regardless of current regulatory approval statuses and potentials for abuse, multiple agents should not be dismissed prematurely as possible treatments for substance use disorders. However, further clinical research is needed before effective implementation can begin in practice.

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Prenatal Effects of Nicotine on Obesity Risks: A Narrative Review

Journal: International Journal of Environmental Research & Public Health, 2022, doi: 10.3390/ijerph19159477

Authors: Olivia White, Nicole Roeder, Kenneth Blum, Rina D. Eiden & Panayotis K. Thanos


Nicotine usage by mothers throughout pregnancy has been observed to relate to numerous deleterious effects in children, especially relating to obesity. Children who have prenatally been exposed to nicotine tend to have lower birth weights, with an elevated risk of becoming overweight throughout development and into their adolescent and adult life. There are numerous theories as to how this occurs: catch-up growth theory, thrifty phenotype theory, neurotransmitter or endocrine imbalances theory, and a more recent examination on the genetic factors relating to obesity risk. In addition to the negative effect on bodyweight and BMI, individuals with obesity may also suffer from numerous comorbidities involving metabolic disease. These may include type 1 and 2 diabetes, high cholesterol levels, and liver disease. Predisposition for obesity with nicotine usage may also be associated with genetic risk alleles for obesity, such as the DRD2 A1 variant. This is important for prenatally nicotine-exposed individuals as an opportunity to provide early prevention and intervention of obesity-related risks.

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The Impact of the COVID-19 Pandemic on Adolescent Mental Health and Substance Use

Journal: Journal of Adolescent Health, 2022, doi: 10.1016/j.jadohealth.2022.05.025

Authors: Jeff R. Temple, Elizabeth Baumler, Leila Wood, Shannon Guillot-Wright, Elizabeth Torres & Melanie Thiel


Purpose: The aim of this study is to determine whether COVID-19-induced financial impact, stress, loneliness, and isolation were related to perceived changes in adolescent mental health and substance use.

Methods: Data were from Baseline (2018) and Wave 3 (2020; mean age = 14.8; 50% female) of 1,188 adolescents recruited from 12 Texas public middle schools as part of a randomized controlled trial. Participants were primarily Black (23%), Latinx (41%), Asian (11%), and White (9%). We assessed mental health and substance use (Baseline and Wave 3) and pandemic-related physical interaction, loneliness, stress, family conflict, and economic situation (Wave 3).

Results: COVID-19-induced stress and loneliness were linked to depression (beta = 0.074, p ≤ .001; beta = 0.132, p ≤ .001) and anxiety (beta = 0.061, p = .001; beta = 0.088, p ≤ .001) among ethnically diverse adolescents. Adolescents who did not limit their physical interactions due to COVID-19 had fewer symptoms of depression (beta = -0.036, p = .03); additionally, adolescents who did not restrict their socializing were substantially more likely to report using a variety of substances (e.g., for episodic heavy drinking; odds ratio = 1.81, p = .001). Increased use of a food bank was linked to depression (beta = 0.063, p ≤ .001) and a negative change in financial situation was linked to increased alcohol use (odds ratio = 0.70, p = .04) among adolescents.

Discussion: After controlling for prepandemic psychopathology and race/ethnicity, COVID-19 induced isolation, loneliness, stress, and economic challenges were linked to poor mental health and substance misuse. Substantial structural, community, school, and individual level resources are needed to mitigate the impact of the COVID-19 pandemic on adolescent psychosocial health.

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Acceptability of a Fentanyl Vaccine to Prevent Opioid Overdose and Need for Personalized Decision-Making

Journal: Clinical Infectious Diseases, 2022, doi: 10.1093/cid/ciac344

Authors: Elissa R. Weitzman, Joe Kossowsky, Laura M. Blakemore, Rachele Cox, David J. Dowling, Ofer Levy, Emma W. Needles & Sharon Levy


Background: The opioid epidemic worsened during the coronavirus disease 2019 (COVID-19) pandemic. Synthetic opioids (primarily fentanyl) comprise the most common drugs involved in overdose (OD) death. A vaccine that blocks fentanyl from reaching the brain to prevent OD is under development, and insight is needed into its acceptability.

Methods: Using a semi-structured interview guide, persons with opioid use disorder (OUD), family, professionals, and the public were interviewed about attitudes and concerns regarding a fentanyl vaccine. Reactions to fictional clinical vignettes of persons at risk of OUD because of pain and/or substance use histories were collected, analyzed, and quantified for favorability. Interviews were transcribed, coded, and analyzed thematically.

Results: Among N = 64 participants, (70.3% female, average age 32.4 years), attitudes were favorable toward a fentanyl vaccine, with preference for lifelong durability (76% of n = 55 asked). Perceived benefits centered on the potential for a life-saving intervention, suffering averted, healthcare dollars saved, and the utility of a passive harm reduction strategy. Concerns centered on uncertainty regarding vaccine safety, questions about efficacy, worry about implications for future pain management, stigma, and need for supportive counseling and guidance to personalize decision making. Reactions to vignettes revealed complex attitudes toward fentanyl vaccination when considering recipient age, health history, and future risks for addiction and pain.

Conclusions: Positive responses to a fentanyl vaccine were found along with appreciation for the complexity of a vaccine strategy to prevent OD in the setting of pain and uncertain durability. Further research is needed to elucidate operational, ethical, and communications strategies to advance the model.

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The Impact of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Substance Use in the United States

Journal: Clinical Infectious Diseases, 2022, doi: 10.1093/cid/ciac311

Authors: Jennifer A. Ross, Patrice K. Malone & Sharon Levy


The SARS-CoV-2 pandemic has been associated with dramatic increases in substance use, as marked by increased alcohol, nicotine, and cannabis sales. Lethal opioid overdoses also increased dramatically, especially during the initial phases of the epidemic when lockdowns and social isolation combined with increasing fentanyl contamination of the illicit drug supply resulted in more overdoses and fewer opportunities for rescue. Substance use, and especially inhalational drug use, increases the likelihood of both transmission and severe infection. Youth are especially vulnerable to substance use and have increased risk of long-term problems. These outcomes highlight the need for greater access to substance use treatment. Virtual treatment, which emerged as a promising format during the pandemic, may reduce access barriers. This article reviews trends in substance use during the pandemic, explores root causes of increased use and overdose, and examines the potential to increase treatment through virtual care, especially during future periods of disruption.

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