Tag: amphetamine

The Twin Epidemic: Rising Co-Prescriptions of Opioids and Stimulants in the U.S.

A recent 10-year longitudinal cohort study has unveiled concerning trends in the co-prescription of opioids and stimulants, shedding light on the escalating “twin epidemic” in the United States.

Key Findings:

  • Prevalence of Co-Prescription: Approximately 5.5% of patients received both opioid and stimulant prescriptions during the study period. 
  • Increased Opioid Dosage: Patients co-prescribed stimulants were more likely to escalate their opioid doses over time, with the highest doses observed in the South and West regions.
  • Associated Conditions: Common diagnoses among these patients included depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and chronic pain

Implications:

The concurrent use of opioids and stimulants poses significant risks, including increased chances of overdose, cardiovascular events, and mental health complications. This study emphasizes the need for healthcare providers to carefully consider the implications of co-prescribing these medications and to monitor patients closely.

Call to Action:

It’s crucial to raise awareness about this emerging twin epidemic. Healthcare professionals, policymakers, and patients must collaborate to develop strategies that mitigate risks associated with co-prescriptions and ensure safer prescribing practices.

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New ASAM and AAAP Guidelines for Stimulant Use Disorder: Key Updates

The American Society of Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP) recently released updated guidelines for the treatment of stimulant use disorder (SUD).

  1. Comprehensive Assessment: The guidelines emphasize a thorough assessment of patients, including the use of validated screening tools to diagnose SUD, assess severity, and identify co-occurring mental health disorders.
  2. Evidence-Based Psychosocial Interventions: Behavioral therapies remain the cornerstone of treatment. Cognitive-behavioral therapy (CBT), contingency management (CM), and motivational interviewing (MI) are recommended due to strong evidence of their efficacy.
  3. Pharmacological Treatments: While no medications are currently FDA-approved specifically for stimulant use disorder, the guidelines discuss off-label use of medications like bupropion and naltrexone, which show promise in reducing stimulant use and cravings in some patients.
  4. Harm Reduction Strategies: Recognizing the importance of harm reduction, the guidelines support interventions like needle exchange programs and education on safer use to reduce the risk of infectious diseases and other health complications.
  5. Integrated Care Models: The guidelines highlight the importance of integrated care that combines medical, psychiatric, and social support services, aiming to provide holistic care tailored to individual patient needs.
  6. Special Populations: Specific recommendations are provided for treating special populations, including pregnant individuals, adolescents, and those with co-occurring mental health disorders, recognizing the unique challenges these groups face.
  7. Recovery Support: Emphasis is placed on long-term recovery support, including peer support groups, vocational training, and housing assistance, to help individuals maintain recovery and improve their quality of life.

These guidelines represent a significant step forward in the standardization of care for individuals with stimulant use disorder, aiming to improve outcomes through evidence-based, patient-centered approaches. For clinicians, staying informed and implementing these recommendations can greatly enhance the quality of care provided to this population.

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Are Stimulants Neurotoxic?

Introduction:

The diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) is well established in the field of psychiatry. Not only is it well accepted, but ADHD has dramatically increased over the past 10 years. Some would even say it’s an epidemic in its own right. The use of psychostimulants as a treatment is common practice, and today we are here to discuss the risk of neurotoxicity with ADHD medication.

What Are Psychostimulants

Psychostimulants include methylphenidate (MPH) and mixed amphetamine salts such as Adderall. These remain the most effective and widely used medications for the treatment of ADHD. These medications function by blocking the dopamine reuptake transporter and increase dopamine stimulation at the postsynaptic receptors. These medications work to increase attention and reduce impulsivity but the long-term implications of consistent use are largely unknown. 

Substance Use and Stimulant Prescribing

Most lines of evidence in the literature indicate that these medications do not promote substance use later in life and may even decrease the potential for future substance abuse. I’ve also found lines of evidence that indicate the opposite, but the general consensus in the field is that there is not increased risk for future substance abuse. We do know that drugs that function in a similar manner to these medications result in molecular and structural changes to neurons. It is unknown if this also occurs with stimulant medications used to treat ADHD. 

Neuronal Effects of Amphetamine

Methamphetamine is a known neurotoxin and several studies have indicated this in animal models. Recently exposure to amphetamine has been sown to cause impairments on the development of dendritic branching up to 3 months after stopping methylphenidate. In mice there is evidence that MPH use causes loss of dopamine neurons in the substantia nigra which may increase the risk of Parkinson’s disease. Other groups have shown alterations in nerve growth factors and brain derived neurotrophic factor in the frontal cortex after chronic MPH use. When neurons from the prefrontal cortex are exposed to MPH it alters their electrical activity. MPH was found to reduce electrical activity and it persists in a dose dependent fashion even 10 weeks post exposure. In rats the use of MPH is associated with decreased response to normal stimuli and increased response to adverse stimuli. We need to be careful extrapolating this information to humans as these studies were conducted in animal models. 

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