Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement

Addiction neuroscience models posit that recurrent drug use increases reactivity to drug-related cues and blunts responsiveness to natural rewards, propelling a cycle of hedonic dysregulation that drives addictive behavior. Here, we assessed whether a cognitive intervention for addiction, Mindfulness-Oriented Recovery Enhancement (MORE), could restructure reward responsiveness from valuation of drug-related reward back to valuation of natural reward. Before and after 8 weeks of MORE or a support group control, prescription opioid users (N = 135) viewed opioid and natural reward cues while an electroencephalogram biomarker of target engagement was assessed. MORE was associated with decreased opioid cue-reactivity and enhanced capacity to regulate responses to opioid and natural reward cues. Increased positive affective responses to natural reward cues were associated with decreased craving and mediated MORE’s therapeutic effects on opioid misuse. This series of randomized experiments provide the first neurophysiological evidence that an integrative behavioral treatment can remediate hedonic dysregulation among chronic opioid users.

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Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards

Psychological Medicine ◽

10.1017/s0033291721003834 ◽

2021 ◽

pp. 1-10

Author(s):

Eric L. Garland ◽

Spencer T. Fix ◽

Justin P. Hudak ◽

Edward M. Bernat ◽

Yoshio Nakamura ◽

...

Keyword(s):

Chronic Pain ◽

Skin Conductance Level ◽

Opioid Therapy ◽

Opioid Use Disorder ◽

Opioid Use ◽

Natural Reward ◽

Before And After ◽

Natural Rewards ◽

Chronic Opioid Use ◽

Opioid Users

Abstract Background Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Methods Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Results Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. Conclusions MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

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Buprenorphine pharmacotherapy and behavioral treatment: Comparison of outcomes among prescription opioid users, heroin users and combination users

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2014.06.006 ◽

2015 ◽

Vol 48 (1) ◽

pp. 70-76 ◽

Cited By ~ 14

Author(s):

Suzanne Nielsen ◽

Maureen Hillhouse ◽

Larissa Mooney ◽

Alfonso Ang ◽

Walter Ling

Keyword(s):

Behavioral Treatment ◽

Prescription Opioid ◽

Heroin Users ◽

Treatment Comparison ◽

Opioid Users

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Validating Anti-Infective Activity of Pleurotus Opuntiae via Standardization of Its Bioactive Mycoconstituents through Multimodal Biochemical Approach

Coatings ◽

10.3390/coatings11040484 ◽

2021 ◽

Vol 11 (4) ◽

pp. 484

Author(s):

Aprajita Tiwari Pandey ◽

Ishan Pandey ◽

Anurag Kanase ◽

Amita Verma ◽

Beatriz Garcia-Canibano ◽

...

Keyword(s):

Bioactive Compounds ◽

High Performance ◽

Colorimetric Assay ◽

Diffusion Method ◽

Therapeutic Effects ◽

Medication Regimen ◽

Methanol Extracts ◽

Retention Factors ◽

Before And After ◽

Solvent Systems

Mushrooms produce a variety of bioactive compounds that are known to have anti-pathogenic properties with safer and effective therapeutic effects in human disease prognosis. The antibacterial activity of ethanol and methanol extracts of Pleurotus opuntiae were checked against pathogenic microorganisms viz. Pseudomonas aeruginosa ATCC 27853, Proteus mirabilis NCIM 2300, Proteus vulgaris NCIM 5266, Serratia marcescens NCIM 2078, Shigella flexeneri NCIM 5265, Moraxella sp. NCIM 2795, Staphylococcus aureus ATCC 25923 by agar well diffusion method at different concentrations of the extracts. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of the extracts was determined by INT (Iodonitrotetrazolium chloride) colorimetric assay. Extracts were standardized by thin layer chromatography (TLC) in different solvent systems. The Retention factors (Rf) of different compounds were calculated by high performance TLC (HPTLC) fingerprinting at UV 254, 366, and 540 nm before and after derivatization. The ethanol and methanol extracts of P. opuntiae showed bactericidal activity against all the test pathogens at MIC values of 15.6 to 52.08 mg/mL and 20.81 to 52.08 mg/mL respectively. Whereas the MBC values for ethanol and methanol extract of P. opuntiae against all pathogens were recorded as 26.03 to 62.5 mg/mL and 125 mg/mL respectively. Preliminary mycochemical screening of both the extracts revealed high contents of bioactive compounds. Amongst all the solvent systems used in TLC, the best result was given by chloroform + hexane (8:2) which eluted out 5 different compounds (spots). HPTLC results revealed spots with different Rf values for all the 24 compounds present. Thus, it can be inferred from the present investigation that the mycoconstituents could be an alternative medication regimen and could play a role in new drug discoveries against different infections. Further, the antimicrobial components of these mushrooms can be transformed to bioengineered antimicrobial coatings for surfaces, drug and other hybrid systems for public health implications in combating persistent infections.

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Opioid dosing among patients with 3 or more years of continuous prescription opioid use before and after the CDC opioid prescribing guideline

International Journal of Drug Policy ◽

10.1016/j.drugpo.2021.103308 ◽

2021 ◽

Vol 97 ◽

pp. 103308

Author(s):

Joanne Salas ◽

Xue Li ◽

Hong Xian ◽

Mark D. Sullivan ◽

Jane C. Ballantyne ◽

...

Keyword(s):

Prescription Opioid ◽

Opioid Use ◽

Opioid Prescribing ◽

Before And After ◽

Prescription Opioid Use

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354 Trends in the Drug-Sparing Effects for Benzodiazepines and Prescription Opioids among Insomnia Patients on Suvorexant in the US

SLEEP ◽

10.1093/sleep/zsab072.353 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A141-A141

Author(s):

Hrishikesh Kale ◽

Rezaul Khandker ◽

Ruchit Shah ◽

Marc Botteman ◽

Weilin Meng ◽

...

Keyword(s):

Interrupted Time Series ◽

Charlson Comorbidity Index Score ◽

Prescription Opioid ◽

Prescription Opioids ◽

Opioid Use ◽

Before And After ◽

Prescription Opioid Use ◽

Incident Cohort ◽

Over Time ◽

Post Period

Abstract Introduction Use of benzodiazepines to treat insomnia has been associated with serious side effects and abuse potential. Insomnia patients are at high risk of opioid abuse and better sleep patterns may help to reduce opioid use. This study examined the trend in the use of benzodiazepines and prescription opioids before and after initiation of suvorexant in insomnia patients. Methods The study analyzed 2015–2019, Optum Clinformatics Data Mart. Insomnia patients, identified using ICD-9/10 codes and prescribed suvorexant were included. The study included incident (newly diagnosed) and prevalent cohorts of insomnia patients. The proportion of patients on benzodiazepines or prescription opioids were calculated for 12 monthly intervals before (pre-period) and after initiation of suvorexant (post-period). Interrupted time series (ITS) analysis was conducted to assess trends for use of benzodiazepine or prescription opioids over time. Results A total of 5,939 patients from the incident insomnia cohort and 18,920 from the prevalent cohort were included. For the incident cohort, mean age was 64.47 (SD: 15.48), 63% were females, 71% had Medicare Advantage coverage, 59% had Charlson comorbidity index score (CCI) ≥ 1, 27% had an anxiety disorder and 16% had substance abuse disorder. Prevalent insomnia cohort was similar but had higher CCI. Results from ITS suggested that at the beginning of the pre-period, 28% of incident insomnia patients used either opioids or benzodiazepines with the rate of use in the pre-period increasing by 0.11% per month. In the post-period, the rate of use decreased by 0.33% per month. About 26% patients used benzodiazepines or opioids at 12-month after suvorexant initiation. In the absence of suvorexant, this proportion would have been 31%. Similar findings were observed for the prevalent insomnia cohort. A larger decrease was observed for opioid use than benzodiazepines. Conclusion The rate of benzodiazepines or prescription opioid use decreased over time after the initiation of suvorexant. Suvorexant has the potential to reduce the use of opioids and benzodiazepines among insomnia patients. Further research is needed to confirm these findings. Support (if any) This study was sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

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The association of prefrontal cortex response during a natural reward cue-reactivity paradigm, anhedonia, and demoralization in persons maintained on methadone

Addictive Behaviors ◽

10.1016/j.addbeh.2020.106673 ◽

2021 ◽

Vol 113 ◽

pp. 106673

Author(s):

Andrew S. Huhn ◽

Robert K. Brooner ◽

Mary M. Sweeney ◽

Denis Antoine ◽

Alexis S. Hammond ◽

...

Keyword(s):

Prefrontal Cortex ◽

Cue Reactivity ◽

Natural Reward

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The cue-reactivity paradigm: An ensemble of networks driving attention and cognition when viewing drug and natural reward-related stimuli

Neuroscience & Biobehavioral Reviews ◽

10.1016/j.neubiorev.2021.08.010 ◽

2021 ◽

Author(s):

Lauren D. Hill-Bowen ◽

Michael C. Riedel ◽

Ranjita Poudel ◽

Taylor Salo ◽

Jessica S. Flannery ◽

...

Keyword(s):

Cue Reactivity ◽

Natural Reward

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Comparative study between oral acetaminophen and lidocaine spray on endotracheal tube-related sore throat in adult intensive care

10.22514/sv.2021.042 ◽

2021 ◽

Keyword(s):

Intensive Care ◽

Pain Management ◽

Endotracheal Tube ◽

Sore Throat ◽

Common Source ◽

Therapeutic Effects ◽

Throat Pain ◽

High Satisfaction ◽

Before And After ◽

Lidocaine Spray

ackground/Purpose: Endotracheal tube (ETT)-related sore throat is a common source of stress in intensive care. Quantitative studies on therapy for ETT-related sore throat remain limited. The current study evaluated the therapeutic effects of oral acetaminophen (ACT) and lidocaine (LIDO) spray on pain relief for ETT-related sore throat in intensive care. Methods: Patients who could communicate with caregivers non-verbally and who had acquired ETT-related sore throat at a medical intensive care unit (ICU) were enrolled. The medications were dispensed at the request of the patients. The intensity of ETT-related throat pain was recorded for quantitative comparison before and after patients received 500 mg of ACT orally or one dose of 10% LIDO spray locally. Before leaving the ICU, the patients were interviewed by a research nurse to assess the effect of these interventions on satisfaction with pain management for ETT-related sore throat. Results: We enrolled 89 patients during the study period, and the intensity of ETT-related throat pain significantly decreased after treatment (6.97 in 5 min before vs. 3.60 in 120 min after oral ACT, P < 0.001; 8.56 in 5 min before vs. 4.12 in 120 min after LIDO application, P < 0.001). The degree of pain reduction over time differed between the ACT and LIDO groups. Patients in the LIDO group made more requests for additional therapy compared with patients in the ACT group (1 LIDO spray per request for an average of 4.7 requests vs. 1 ACT dose per request for an average of 1.3 requests, P < 0.001). Patients in both the ACT and LIDO groups reported high satisfaction with pain management for ETT-related sore throat (87.3 of 100 vs. 86.5 of 100, respectively, P = 0.805). Conclusion: ACT and LIDO treatment can effectively attenuate ETT-related sore throat. Patients were highly satisfied with pain management for ETT-related sore throat after both oral ACT and local LIDO application.

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