Intranasal Oxytocin for Stimulant Use Disorder Among Male Veterans Enrolled in an Opioid Treatment Program: A Randomized Controlled Trial

The increasing prevalence of illicit stimulant use among those in opioid treatment programs poses a significant risk to public health, stimulant users have the lowest rate of retention and poorest outcomes among those in addiction treatment, and current treatment options are limited. Oxytocin administration has shown promise in reducing addiction-related behavior and enhancing salience to social cues. We conducted a randomized, double-blind, placebo-controlled clinical trial of intranasal oxytocin administered twice daily for 6 weeks to male Veterans with stimulant use disorder who were also receiving opioid agonist therapy and counseling (n = 42). There was no significant effect of oxytocin on stimulant use, stimulant craving, or therapeutic alliance over 6 weeks. However, participants receiving oxytocin (vs. placebo) attended significantly more daily opioid agonist therapy dispensing visits. This replicated previous work suggesting that oxytocin may enhance treatment engagement among individuals with stimulant and opioid use disorders, which would address a significant barrier to effective care.

The Role of Ghrelin/GHS-R1A Signaling in Nonalcohol Drug Addictions

Drug addiction causes constant serious health, social, and economic burden within the human society. The current drug dependence pharmacotherapies, particularly relapse prevention, remain limited, unsatisfactory, unreliable for opioids and tobacco, and even symptomatic for stimulants and cannabinoids, thus, new more effective treatment strategies are researched. The antagonism of the growth hormone secretagogue receptor type A (GHS-R1A) has been recently proposed as a novel alcohol addiction treatment strategy, and it has been intensively studied in experimental models of other addictive drugs, such as nicotine, stimulants, opioids and cannabinoids. The role of ghrelin signaling in these drugs effects has also been investigated. The present review aims to provide a comprehensive overview of preclinical and clinical studies focused on ghrelin’s/GHS-R1A possible involvement in these nonalcohol addictive drugs reinforcing effects and addiction. Although the investigation is still in its early stage, majority of the existing reviewed experimental results from rodents with the addition of few human studies, that searched correlations between the genetic variations of the ghrelin signaling or the ghrelin blood content with the addictive drugs effects, have indicated the importance of the ghrelin’s/GHS-R1As involvement in the nonalcohol abused drugs pro-addictive effects. Further research is necessary to elucidate the exact involved mechanisms and to verify the future potential utilization and safety of the GHS-R1A antagonism use for these drug addiction therapies, particularly for reducing the risk of relapse.

The Perspective of Traditional Persian Medicine on Botanicals Effective in Quitting Opium Addiction: A Review

Traditional Persian medicine (TPM) is a set of theoretical and practical sciences that are used in the diagnosis, prevention, and treatment of physical, mental, or social disorders. This holistic medical system can provide solutions for some diseases, including drug addiction, that modern medicine, only offers symptomatic treatment. Since the addiction prevalence in the 16th century, Persian medicine scholars have introduced various ways to quit it. In this study, we investigated if Persian medicine has treatment options to quit opium addiction. We studied the main textbooks of TPM that specifically talked about addiction. Our study was conducted according to a systematic prioritization in traditional medicine. Additionally, scientific databases such as PubMed, ScienceDirect, Scopus, and Google Scholar searched for plant active ingredients in current pharmacology. By this method, forty-nine drugs were found, and nine drugs with herbal origin obtained the highest score in addiction treatment. Since the main purpose of the study is finding new drugs theoretically effective in quitting opium addiction; we sought to find evidence of that effectiveness in modern pharmacology and we found them in most prioritized drugs. Prioritizing traditional drugs can lead to find new drugs which also have evidence of effectiveness in modern studies. Therefore, they could be introduced as novel natural remedies for disease. The list of drugs obtained in this study can be the basis for conducting in vitro and in vivo studies for design and development of new drugs in the treatment of opium addiction. In fact, traditional medicine could have a special place in quitting opium addiction, and this capacity should be further exploited.

Evolution of policy for the treatment of substance use disorders in Qatar

There is a marked paucity of published evidence on the extent and nature of substance use disorders in the State of Qatar. This is mirrored by a dearth of information on the policy for the treatment of substance use disorders in the public domain. Between 2007 and 2017, substance use disorders have risen from the third to leading cause of disability in Qatar. More recently, Qatar has shifted from applying a punitive only paradigm in managing substance use problems to recognizing the role of treatment and care for people with substance use disorders. Recently published official documents in Qatar define addiction as a disease and as a chronic condition where people with substance use disorders should be treated as patients who need care and assistance. This shifts the onus of providing, and developing services, for individuals with substance use disorders with healthcare providers rather than purely with the criminal justice system. Following cabinet approval, the recently established Permanent Committee for Addiction Treatment headed by the Minister of Public Health, signals the need to institutionalize systems and structures to upscale demand reduction programmes in the country. This article is a descriptive examination of the shifts in substance abuse treatment policy in Qatar, the major factors influencing this evolution, and will utilise some of the policy science theories to describe and analyse policy outcomes. The article will also frame the substance use problem in Qatar for the first time, based on documents published by various government organisations.

Telehealth Services for Substance Use Disorders: A 3-month Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices During the COVID-19 Pandemic (Preprint)

BACKGROUND The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatment to telehealth formats, despite limited information about what makes treatment effective in this novel format. OBJECTIVE To examine the feasibility and effectiveness of virtual intensive outpatient program (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. METHODS The study is based on a longitudinal study with a baseline sample of 3,642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month post-discharge outcome survey as part of routine outcome monitoring (n = 1,060) (response rate = 29%). RESULTS No significant differences were detected by delivery format in continuous abstinence (χ2 = 0.42, P = .81), overall quality of life (F(2,826) = 2.06, P = .13), financial well-being (F(2,767) = 2.30, P = .10), psychological well-being (F(2,918) = 0.72, P = .49), and confidence in one’s ability to stay sober (F(2,941) = 0.21, P = .81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F(2,917) = 4.19, P = .01). CONCLUSIONS Virtual outpatient care for the treatment of SUDs is a feasible alternative to in-person only programming leading to similar self-reported outcomes at 3-months post-discharge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care.

Acute Burn Treatment and History of Drug and Alcohol Addiction: Treatment Outcomes and Opioid Use

Treating pain in burn patients with a history of opioid or drug abuse is challenging. There is no consensus on pain management for burn patients with a history of drug usage. Our aim was to study the association of previous drug addiction and the treatment of acute burn patients, focusing on daily morphine milligram equivalent (MME) requirements and outcomes. We compared patients with (group 1) and without (group 2) a drug addiction history who were admitted to an American Burn Association verified burn center using the Premier database from 2013 to 2018 (n = 3046). Primary outcome was daily MME usage. Secondary outcomes included mortality, expected mortality rate, length of stay (LOS), and number of surgeries. Linear regression was performed to predict MME usage. In total, 16.6% of patients had history of drug abuse. In unadjusted analysis, group 1 had more males (68.1% vs. 57.3%, p < 0.001) and was younger (median 47 vs. median 53, p < 0.001) compared to group 2. In the adjusted analysis, group 1 required 84.1 additional daily MME usage than group 2 (p < 0.01). Drug addiction was associated with an increased number of surgeries, LOS, and higher daily MME usage. Patients with a history of drug usage required almost 60 mg of additional oxycodone per day.