Shrinks In Sneakers

Tag: addiction psychiatry

  • Beyond Blood Sugar: GLP-1 Agonists Show Promise in Cutting Alcohol Cravings

    Beyond Blood Sugar: GLP-1 Agonists Show Promise in Cutting Alcohol Cravings

    Recent research in JAMA and JCI Insight on repurposing GLP-1 receptor agonists, particularly semaglutide and liraglutide, for Alcohol Use Disorder (AUD) shows promise.

    1. Mechanism of Action: Semaglutide and liraglutide, commonly used to manage diabetes and obesity, activate the GLP-1 receptor, which plays a role in satiety and reward pathways. This activation has shown to suppress the rewarding effects of alcohol, aligning with existing data on the overlap between mechanisms regulating food intake and addictive behaviors.
    2. Preclinical Findings: In rodent models, semaglutide reduced alcohol intake in a dose-dependent manner, with promising results across both binge drinking and alcohol-dependent models. Compared to other GLP-1 agonists, semaglutide’s potent binding and prolonged action make it a strong candidate for further study.
    3. Clinical Potential: The findings provide a foundation for testing semaglutide in clinical trials for people with AUD, where it could potentially serve as an alternative to traditional treatments by targeting alcohol cravings and reducing consumption patterns in those with AUD.

    The promising preclinical data suggests that further investigation could potentially lead to semaglutide as a viable treatment for AUD, adding to the treatment options for substance use disorders that overlap with metabolic disorders. This research is ongoing, and clinical trials may help solidify its role in AUD treatment in the future.

  • Clearing the Smoke: What We Know About Cannabis for Mental Health Treatment

    Clearing the Smoke: What We Know About Cannabis for Mental Health Treatment

    Research into the therapeutic potential of cannabis for mental health disorders has grown in recent years, with mixed findings from randomized controlled trials (RCTs).

    Anxiety Disorders

    • CBD (Cannabidiol) has shown promise in reducing anxiety symptoms in RCTs, particularly for social anxiety disorder (SAD). For instance, a small RCT found that a single dose of 300 mg of CBD reduced anxiety levels in participants undergoing a simulated public speaking test.
    • Some RCTs suggest that CBD may be anxiolytic without causing impairment or euphoria, making it preferable for anxiety compared to THC-dominant cannabis products, which may exacerbate anxiety in some users.

    Post-Traumatic Stress Disorder (PTSD)

    • RCTs exploring THC and CBD combinations in PTSD have had mixed outcomes. Some studies indicate that THC may reduce nightmares and improve sleep in PTSD patients, though these findings are generally based on small sample sizes and short-term trials.
    • A recent RCT with a synthetic cannabinoid (nabilone) reported some symptom improvement in PTSD-related insomnia and nightmares. However, larger trials with longer follow-ups are necessary to clarify the efficacy and safety for PTSD.

    Depression

    • Few RCTs show consistent evidence supporting cannabis (CBD or THC) as an effective treatment for major depressive disorder. Some trials indicate that CBD may have antidepressant-like effects, possibly due to serotonin receptor activity, but more robust and long-term studies are needed.
    • Concerns persist over THC’s potential to exacerbate depressive symptoms, particularly with regular or heavy use.

    Schizophrenia and Psychotic Disorders

    • THC-dominant products have been associated with increased risk of psychosis and exacerbation of symptoms in people predisposed to psychotic disorders. This has led to caution against THC use in people with schizophrenia.
    • CBD has shown promise as an adjunctive treatment in some RCTs, with findings suggesting that it may have antipsychotic effects without the psychoactive effects of THC. For example, an RCT found that CBD reduced psychotic symptoms and improved cognitive function when added to standard antipsychotic treatment, though the effects were modest.

    Bipolar Disorder

    • Evidence from RCTs on the use of cannabis in bipolar disorder is sparse and generally negative. Some trials indicate that THC may worsen manic and depressive symptoms in bipolar patients, and there is little to no support for cannabis as a treatment for bipolar depression.

    Sleep Disorders

    • Some RCTs have evaluated cannabinoids for sleep disturbances, with CBD showing potential for improving sleep quality. However, THC may reduce REM sleep, which could impact sleep architecture negatively over time.
    • For PTSD-related insomnia, cannabinoids like nabilone have shown some benefit, but the effects on sleep in general populations remain uncertain.

    Limitations

    • Sample Sizes and Duration: Many RCTs are small and short-term, limiting the generalizability and understanding of long-term effects.
    • Dosing and Formulations: Variability in cannabinoid content (THC vs. CBD), formulations (edibles, oils, vapes), and dosages across studies makes comparison challenging.
    • Side Effects: Both CBD and THC can have side effects, though THC’s psychoactive properties can lead to cognitive impairment, addiction potential, and negative impact on mood in some patients.

    While CBD shows some promise in anxiety, PTSD, and psychotic disorders, RCT evidence for other mental health conditions remains inconclusive or even negative, especially with THC. Further large-scale, long-term RCTs are needed to establish the efficacy and safety profile of cannabis-based treatments in mental health.

  • Raising the Bar: Should Buprenorphine Doses Be Higher to Combat Opioid Use Disorder?

    Raising the Bar: Should Buprenorphine Doses Be Higher to Combat Opioid Use Disorder?

    The study “Association of Daily Doses of Buprenorphine With Urgent Health Care Utilization” explored how different buprenorphine doses affect emergency department (ED) and inpatient service use among individuals with opioid use disorder (OUD).

    1. Higher Doses Associated with Fewer Acute Care Visits: Patients receiving higher doses of buprenorphine (above 16 mg/day) had a longer time to ED or inpatient visits compared to those on lower doses (8-16 mg/day). Those on doses over 24 mg saw a significant reduction in the need for urgent care, particularly related to behavioral health crises.
    2. Implications for Fentanyl Users: The findings are particularly relevant for those using synthetic opioids like fentanyl, which often require higher doses of buprenorphine to manage withdrawal symptoms effectively. These higher doses may reduce acute care needs and improve overall treatment outcomes.
    3. Policy Considerations: The study highlights potential barriers, such as restrictive state laws or insurance limitations, that may prevent patients from accessing higher buprenorphine doses, which could limit effective treatment.

    These results suggest that modifying buprenorphine dosing guidelines could be beneficial, especially as the opioid crisis evolves with the prevalence of fentanyl​

    Link to article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2824049

  • Liam Payne and Pink Cocaine: What You Need to Know About the Party Drug

    Liam Payne and Pink Cocaine: What You Need to Know About the Party Drug

    Pink cocaine, also known as tucibi or 2C-B, is a synthetic hallucinogen from the phenethylamine family, first synthesized in the 1970s. Despite the “cocaine” in its street name, it is chemically unrelated to cocaine. It usually comes in powder form but can also be found in tablets. It’s popular in party scenes for its euphoric and stimulant effects, which are often compared to a combination of MDMA and LSD.

    Key Points for Addiction Psychiatrists:

    1. Effects:
      • Euphoria, enhanced sensory perception, hallucinations.
      • At higher doses, it can cause anxiety, paranoia, and dissociation.
      • Effects can last from 4-8 hours depending on the dose and mode of administration (oral, nasal).
    2. Health Risks:
      • Cardiovascular issues, including hypertension and tachycardia.
      • Risk of psychosis and mood disorders, especially with repeated use.
      • Hyperthermia and dehydration, especially in party environments.
      • Possible neurotoxic effects, though research is limited.
    3. Addiction and Dependence:
      • While physical dependence is not common, psychological dependence can develop due to its euphoric effects.
      • Patients may use it in cycles with other substances (e.g., MDMA, alcohol), leading to polysubstance abuse.
    4. Withdrawal:
      • No specific withdrawal syndrome has been documented, but patients may experience depression, anxiety, and cravings after discontinuation.
      • Management may require addressing underlying mental health issues or substance use patterns.
    5. Treatment:
      • Cognitive-behavioral therapy (CBT) or motivational interviewing may help address compulsive use.
      • Monitor for concurrent use of other drugs, especially stimulants or hallucinogens, as polysubstance abuse is common.
      • Referral to harm-reduction programs may be beneficial for patients unwilling to quit completely.
    6. Legal Status:
      • It is illegal in most countries, classified as a Schedule I drug in the U.S. However, enforcement is inconsistent, and it continues to be accessible in underground markets.

    For addiction psychiatrists, it’s crucial to recognize tucibi use, especially in patients with party-drug histories. Understanding the psychological effects and potential for dependence will aid in developing a comprehensive treatment plan. Monitoring for concurrent substance use and educating patients on the risks is key.

  • Contingency Management: The Overlooked Game-Changer for Methamphetamine Use Disorder

    Contingency Management: The Overlooked Game-Changer for Methamphetamine Use Disorder

    I frequently encounter patients with methamphetamine use disorder, and I don’t know about you, but finding effective interventions in the inpatient psychiatric setting can be a real challenge. Unlike opioid or alcohol use disorders, where we have biological interventions like buprenorphine or naltrexone, methamphetamine use disorder lacks such clear pharmacological treatments. Because of this, many rehab facilities are reluctant to admit patients whose primary issue is methamphetamine use.

    In my practice, I often turn to combinations like bupropion and naltrexone since they’re among the few studied pharmacological options for methamphetamine use disorder. However, based on my experience, the results are modest at best—but I suppose it’s better than nothing.

    That said, there’s a much simpler, evidence-based option that doesn’t even require inpatient treatment, and it’s been around since the 1980s: Contingency Management. The concept is straightforward: reward patients with small incentives—like gift cards worth $30 or less—for each negative drug screen they produce. As patients continue to test negative, the rewards increase. This approach has been shown to double the chances of success in stopping methamphetamine use.

    Of course, there are potential issues, such as concerns about fraud or patients providing fake samples. But let’s be real—how much are we already spending on treating methamphetamine users without seeing much improvement? Probably a lot more. With contingency management, we’re not just spending money—we’re actually seeing patients get better.

  • Recent Data Shows Marijuana Use Surpasses Alcohol in the U.S.

    Recent Data Shows Marijuana Use Surpasses Alcohol in the U.S.

    For the first time in U.S. history, recent data shows that marijuana use has overtaken alcohol consumption. According to surveys and studies, more Americans now regularly consume cannabis than alcohol, marking a significant cultural and behavioral shift. This trend is driven by several factors:

    • Legalization: Recreational marijuana is now legal in 23 states and Washington, D.C., making it more accessible to adults across the country.
    • Changing Social Attitudes: Perceptions about marijuana have shifted, with more people viewing it as a safer, less harmful alternative to alcohol.
    • Health and Wellness Trends: Some individuals are opting for cannabis to manage stress, anxiety, and pain without the perceived risks of alcohol, such as liver damage and hangovers.

    As a frontline healthcare worker, I can say with certainty that chronic, high-potency marijuana use can have serious implications for both physical and mental health. While some claim potential benefits, we currently lack comprehensive data on its medical efficacy, and more importantly, we do not yet fully understand the long-term consequences of regular, heavy consumption. As marijuana use increases, it’s critical to approach it with caution and prioritize further research into its effects on overall health.

  • Locked Out: Why Most Inmates Are Denied Life-Saving Opioid Treatment

    Locked Out: Why Most Inmates Are Denied Life-Saving Opioid Treatment

    The JAMA Network Open article titled “Factors Associated With the Availability of Medications for Opioid Use Disorder in US Jails” investigates the availability of medications for opioid use disorder (MOUD) in U.S. jails, such as methadone, buprenorphine, and naltrexone. It highlights that MOUD, which is a critical component in treating opioid use disorder (OUD), is underutilized in correctional facilities, despite its effectiveness in reducing overdose rates, withdrawal symptoms, and recidivism.

    Key factors influencing MOUD availability in jails include jail size, regional location, the political landscape, and resources available in the facility. Jails in larger urban areas or those in states with Medicaid expansion are more likely to provide MOUD. Barriers such as stigma, lack of funding, and inadequate healthcare infrastructure also limit access to these medications.

    The study emphasizes the importance of expanding access to MOUD in jails to address the opioid epidemic and improve public health outcomes for incarcerated populations as only 44% of jails offer MOUD in the current system. 

  • Psilocybin Outshines Escitalopram: A Breakthrough in Depression Treatment

    Psilocybin Outshines Escitalopram: A Breakthrough in Depression Treatment

    The article Effect of psilocybin versus escitalopram on depression symptom severity in patients with moderate-to-severe major depressive disorder: observational 6-month follow-up of a phase 2, double-blind, randomised, controlled trialreports findings from an extended observation period on the comparative effects of psilocybin and escitalopram in treating depression. Here are the key points:

    Study Design: This was a 6-month follow-up of a Phase 2, double-blind, randomized controlled trial. It compared the effects of psilocybin (a psychedelic compound) and escitalopram (a common SSRI) on depression symptoms in patients with moderate-to-severe major depressive disorder (MDD).

    Participants: Patients with moderate-to-severe MDD were randomly assigned to either psilocybin or escitalopram groups. Both treatments were administered in a controlled clinical setting

    Primary Outcome: Depression symptom severity was measured using the QIDS-SR-16 (Quick Inventory of Depressive Symptomatology–Self-Report) scale at various time points, including baseline, during the treatment phase, and at the 6-month follow-up.

    Results:

    Both groups showed improvement in depression symptoms, but the psilocybin group had a greater reduction in symptoms compared to the escitalopram group.

    The effects of psilocybin were found to be more rapid and sustained over the 6-month period.

    Remission and Response Rates: A higher proportion of patients in the psilocybin group achieved remission and clinically significant response compared to those in the escitalopram group.

    Safety and Side Effects: Both treatments were generally well-tolerated. However, psilocybin was associated with transient, mild-to-moderate side effects, mostly during the acute phase of treatment (e.g., perceptual disturbances).

    Conclusion: Psilocybin demonstrated more pronounced and longer-lasting antidepressant effects compared to escitalopram at the 6-month follow-up. This suggests that psilocybin could be a viable alternative treatment for moderate-to-severe depression, but further research is necessary to confirm long-term safety and efficacy.

  • Want to Live Longer with a Serious Mental Health Condition? Say No to Alcohol, Drugs, and Smoking!

    Want to Live Longer with a Serious Mental Health Condition? Say No to Alcohol, Drugs, and Smoking!

    The article “Major Psychiatric Disorders, Substance Use Behaviors, and Longevity” explores the complex relationships between psychiatric disorders, substance use, and life expectancy. The authors examine how conditions like schizophrenia, bipolar disorder, and major depression affect longevity, often leading to reduced lifespans. This is largely due to increased risk factors, such as poor physical health, unhealthy lifestyles, and increased rates of suicide.

    Substance use behaviors, including alcohol, tobacco, and drug use, often co-occur with psychiatric disorders, compounding the negative effects on longevity. The article emphasizes the need for better integration of mental health and substance use treatment into healthcare systems. It also advocates for targeted interventions to reduce mortality rates, improve the quality of life, and enhance access to comprehensive care for individuals with psychiatric disorders.

    Link to the article: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2820199

  • U.S. Overdose Deaths Hit Historic Low: A Turning Point in the Opioid Crisis

    U.S. Overdose Deaths Hit Historic Low: A Turning Point in the Opioid Crisis

    A recent NPR exclusive reveals a significant and unexpected decline in U.S. overdose deaths, marking the first drop in decades. Data from the Centers for Disease Control and Prevention (CDC) shows a nationwide reduction of roughly 10.6% in overdose deaths. Some states with rapid data collection have seen declines as high as 20-30%, suggesting the possibility of saving up to 20,000 lives annually.

    This turnaround follows years of increasing fatalities, largely driven by fentanyl and other synthetic opioids. Experts credit the broader availability of life-saving treatments, such as naloxone, and improvements in support systems for people at risk of overdosing. While the overall number of overdose deaths remains high, many in the public health community are cautiously optimistic, believing the worst of the crisis might be over for now