The Escalation of the Opioid Crisis

The opioid epidemic has reached alarming heights, with opioid overdose deaths tripling over the past decade. In 2022 alone, the US saw 81,806 opioid-related deaths. This surge has been driven by various waves of opioid misuse, starting with prescription opioids, followed by heroin, synthetic opioids like fentanyl, and most recently, the co-use of stimulants such as methamphetamines and cocaine.

Life Expectancy and Years of Life Lost

The study employed cause-eliminated life tables to estimate the reduction in life expectancy and total YLL due to opioid overdose deaths. The findings are stark: opioid-related deaths in 2022 resulted in an estimated 3.1 million years of life lost, averaging 38 years per death. Nationally, opioid-related mortality reduced life expectancy by 0.67 years in 2022, up from 0.52 years in 2019.

Demographic Disparities

The burden of opioid-related mortality has worsened across all racial and ethnic groups. From 2019 to 2022, life expectancy reductions varied significantly:

• White men: 0.76 years to 0.96 years
• White women: 0.36 years to 0.55 years
• Black men: 0.59 years to 1.1 years
• Black women: 0.27 years to 0.53 years
• Hispanic men: 0.31 years to 0.82 years
• Hispanic women: 0.19 years to 0.31 years
• American Indian/Alaska Native (AI/AN) men: 0.62 years to 1.5 years
• AI/AN women: 0.43 years to 1 year
• Asian men: 0.09 years to 0.2 years
• Asian women: 0.08 years to 0.13 years

These figures indicate a substantial increase in mortality burden, particularly among AI/AN, Black, and Hispanic populations, which now approach or exceed the burden experienced by white Americans.

Polysubstance Use: A Growing Concern

Polysubstance use, especially the co-use of opioids with stimulants like cocaine and methamphetamines, has emerged as a significant factor in opioid-related deaths. In 2022, such combinations were involved in half of all opioid overdose deaths, with variations in predominant drug classes by state and racial/ethnic group.

Geographic Variations

Nearly all states experienced an increase in YLL per capita from 2019 to 2022, with YLL more than doubling in 16 states. West Virginia, Delaware, and Maine saw the highest rates of YLL per capita, while states like Hawaii, Nebraska, and South Dakota reported significantly lower rates.

The COVID-19 Pandemic’s Role

The onset of the COVID-19 pandemic exacerbated the opioid crisis, with disruptions to social, economic, and healthcare systems contributing to the rise in fatal overdoses. The study period coincides with the pandemic years, highlighting the compounded public health challenges.

Implications for Policy and Public Health

Despite significant investments to curb the opioid crisis, opioid overdose mortality has continued to rise. The study underscores the urgent need for transformative policy approaches that address the underlying causes of opioid misuse, enhance access to treatment, and tackle the growing issue of polysubstance use.

Conclusion

The latest findings on the opioid crisis reveal a worsening scenario with significant implications for life expectancy and public health in the US. As the crisis evolves, particularly with the rise in polysubstance use, comprehensive and equitable strategies are crucial to mitigate its impact and save lives. The study calls for renewed and robust efforts to address this ongoing public health emergency.

References

Hébert, A. H., & Hill, A. L. (2024). Impact of opioid overdoses on US life expectancy and years of life lost, by demographic group and stimulant co-involvement: a mortality data analysis from 2019 to 2022. The Lancet Regional Health – Americas, 36, 100813. https://doi.org/10.1016/j.lana.2024.100813

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The Study: An Overview

Conducted by researchers from Kaiser Permanente Northern California and the University of California, San Francisco, the study aimed to explore whether prenatal cannabis use is linked to adverse maternal health outcomes during pregnancy. The population-based retrospective cohort study included 316,722 pregnancies in Northern California from January 2011 to December 2019. The researchers evaluated prenatal cannabis use through self-reports and toxicology tests conducted at around 8-10 weeks of gestation.

Key Findings

The study revealed that prenatal cannabis use is associated with several negative maternal health outcomes. Notably, cannabis use during pregnancy was linked to increased risks of:

• Gestational Hypertension: Pregnant individuals who used cannabis had a 17% higher risk of developing gestational hypertension compared to those who did not use cannabis.
• Preeclampsia: The risk of preeclampsia, a severe form of hypertension that can lead to serious complications, was 8% higher among cannabis users.
• Gestational Weight Gain Outside Guidelines: Both insufficient and excessive weight gain during pregnancy were more common among cannabis users. The risk of gaining less than the recommended weight was 5% higher, while the risk of gaining more than the recommended weight was 9% higher.
• Placental Abruption: The study found a 19% higher risk of placental abruption, a condition where the placenta detaches from the uterus prematurely, among those who used cannabis during pregnancy.

Interestingly, the study also found a decreased risk of gestational diabetes among cannabis users, with a risk reduction of 11%. However, the researchers caution that this finding requires further investigation to understand the underlying mechanisms.

Implications and Future Research

Dr. Kelly C. Young-Wolff, the lead author of the study, emphasized the complexity of the relationship between prenatal cannabis use and maternal health. “Our findings suggest that the use of cannabis during pregnancy can lead to several adverse health outcomes for the mother,” said Dr. Young-Wolff. “Given the increasing prevalence of cannabis use among pregnant individuals, it is crucial to continue researching its effects to provide clear guidelines and support for expecting mothers.”

The study’s results highlight the need for further research to explore how different factors, such as the dose, mode, and timing of cannabis use, might influence these health outcomes. Additionally, there is a need to investigate the potential long-term effects on both maternal and fetal health.

Conclusion

As cannabis legalization continues to expand, it is essential for healthcare providers to understand and communicate the potential risks of prenatal cannabis use to their patients. This study provides valuable insights that can inform clinical guidelines and public health policies aimed at ensuring the health and safety of both mothers and their babies.

For expecting mothers considering or currently using cannabis, it is advised to discuss their use with healthcare providers to weigh the potential risks and benefits carefully. As always, making informed decisions in consultation with medical professionals is the best approach to ensuring a healthy pregnancy and positive outcomes for both mother and child.

References

Young-Wolff, K. C., Adams, S. R., Alexeeff, S. E., Zhu, Y., Chojolan, E., Slama, N. E., Does, M. B., Silver, L. D., Ansley, D., Castellanos, C. L., & Avalos, L. A. (2024). Prenatal Cannabis Use and Maternal Pregnancy Outcomes. JAMA Internal Medicine. Published online July 22, 2024. DOI:10.1001/jamainternmed.2024.3270.

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A Comprehensive Study to Understand Bystander Behavior

A recent study published in the Harm Reduction Journal by Thompson et al. delved deep into the dynamics of bystander responses to opioid overdoses in Connecticut, aiming to identify effective policy options for enhancing the impact of GSLs. This study utilized a systems-level approach, engaging a diverse group of stakeholders through six Group Model Building (GMB) workshops. Participants included medical professionals, community members, first responders, and individuals with lived experience of witnessing overdoses.

Key Findings: The Dynamics of Bystander Behavior

The study’s qualitative system dynamics (SD) model revealed intricate feedback loops and systemic interactions that influence bystander behavior. The model highlighted four key narrative domains:

1. Overdose, Calling 911, and First Responder Burnout: This narrative explored the complex interplay between calling 911 during an overdose and the resulting impact on first responders. Reinforcing feedback loops showed that while calling 911 saves lives, the increased demand on first responders can lead to burnout and stigmatization of individuals with opioid use disorder (OUD), ultimately discouraging future 911 calls.
2. Naloxone Use, Acceptability, and Linking Patients to Services: This narrative underscored the importance of naloxone, a life-saving drug that reverses opioid overdoses. The study found that while increased naloxone use can prevent deaths, its effectiveness is limited if overdose victims are not linked to treatment services, potentially leading to repeated overdoses.
3. Drug Arrests, Belief in Good Samaritan Laws, and Community Trust in Police: The relationship between law enforcement and the community was a critical factor. The fear of arrest and negative interactions with police can deter bystanders from seeking help during overdoses. Building trust and fostering a culture of harm reduction within law enforcement can significantly improve community willingness to call 911.
4. Bystander Naloxone Use, Community Participation in Harm Reduction, and Cultural Change Towards Carrying Naloxone: This narrative highlighted how successful naloxone administration can encourage broader community participation in harm reduction efforts, promoting a cultural shift towards carrying and using naloxone.

High-Leverage Policy Recommendations

Based on the findings, the study identified nine high-impact strategies categorized into four themes:

1. Naloxone Access & Use: Expanding programs like naloxone “leave behind” initiatives and ensuring that EMS, fire, and police departments carry and administer naloxone.
2. Community-Based Harm Reduction Services & Teams: Enhancing connections between overdose victims and addiction treatment services, implementing recovery navigator programs, and providing services at overdose sites.
3. Safer Drug Use: Establishing safe spaces for drug use and developing smartphone applications that alert others in case of an overdose.
4. Education to Reduce Stigma: Training new law enforcement and emergency department staff to reduce stigma and engaging medical trainees to foster a supportive clinical culture.

Conclusion: Towards a Holistic Approach

The study by Thompson et al. underscores the complexity of addressing opioid overdoses and the critical role of systemic, multifaceted approaches. By understanding the dynamics of bystander behavior and the interplay of various social, structural, and policy factors, policymakers can design more effective strategies to reduce opioid-related deaths. Building trust, expanding access to naloxone, and fostering community participation in harm reduction are key steps towards a more resilient and supportive system for individuals with OUD in Connecticut.

For more in-depth insights and detailed policy recommendations, the full study can be accessed here.

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The Experiment

The study employed an innovative approach known as precision functional mapping, involving extensive MRI sessions—about 18 per participant. This method enabled researchers to track individual-specific brain changes before, during, and after administering psilocybin (25 mg) and methylphenidate (40 mg), with a follow-up psilocybin dose 6-12 months later.

Key Findings

1. Massive Disruption of Brain Connectivity:
Psilocybin caused a threefold greater disruption in functional connectivity (FC) compared to methylphenidate. The most pronounced effects were observed in the default mode network (DMN), a crucial brain network associated with our sense of self, space, and time.

2. Desynchronization Across Brain Networks:
The disruptions were characterized by brain desynchronization across various spatial scales, reducing correlations within networks and anticorrelations between networks. This desynchronization suggests a breakdown in the typical patterns of brain activity, leading to a state of increased entropy or randomness.

3. Persistent Effects:
Interestingly, the study found that psilocybin-induced changes in FC between the anterior hippocampus and DMN persisted for weeks. This prolonged decrease in connectivity could be linked to the therapeutic effects observed in clinical trials for conditions like depression and anxiety.

4. Subjective Experiences and Brain Changes:
There was a strong correlation between individual differences in FC changes and the subjective psychedelic experience. The intensity of mystical experiences, measured using the Mystical Experience Questionnaire (MEQ30), was closely linked to the degree of brain network desynchronization.

Therapeutic Implications

The findings shed light on the potential mechanisms underlying the therapeutic effects of psychedelics. The persistent decrease in hippocampal-DMN connectivity, for instance, could represent a neuroanatomical correlate of the proplasticity and therapeutic effects of psilocybin. This aligns with previous animal studies showing increased synaptogenesis and neuroplasticity in the cortex and hippocampus following psychedelic exposure.

The Bigger Picture

The research offers a promising glimpse into how psychedelics can be harnessed to treat mental health disorders. By disrupting the brain’s usual patterns of connectivity, psilocybin might “reset” dysfunctional neural circuits associated with depression, anxiety, and other conditions. However, the study also underscores the need for further research, particularly in clinical settings, to fully understand and optimize these effects for therapeutic use.

Conclusion

Dr. Siegel and his team’s groundbreaking work provides valuable insights into the profound and lasting effects of psilocybin on the human brain. As the scientific community continues to unravel the complexities of psychedelic substances, studies like this highlight their potential to revolutionize mental health treatment, offering hope to millions suffering from debilitating conditions.

References:

• Siegel, J. S., et al. (2024). Psilocybin desynchronizes the human brain. Nature. DOI: 10.1038/s41586-024-07624-5

For more in-depth information and access to the full study, visit Nature’s website.

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The Study’s Objectives

Cocaine craving, a core symptom of CUD, poses significant challenges in addiction treatment. Traditional methods of cue-exposure therapy have shown varying degrees of success, prompting researchers to explore more immersive and engaging techniques. The study aimed to assess the feasibility of using VR to induce cocaine cravings in users, comparing VR exposure to cocaine-related cues with neutral VR environments.

Methodology

The study involved 11 chronic cocaine users, including crack smokers, snorters, and injectors. Participants underwent three 10-minute tasks in a controlled environment:

1. Neutral VR Exposure: Participants interacted with a virtual apartment featuring neutral objects and environments.
2. Cocaine VR Exposure: The same virtual apartment was transformed with cocaine-related stimuli, including paraphernalia and scenarios mimicking drug use.
3. Relaxation Procedure: A paced-breathing relaxation exercise aimed at reducing any residual craving and discomfort.

The primary outcome was measured using the Cocaine Craving Questionnaire-Brief (CCQ-Brief), while secondary outcomes included changes in emotional states and self-efficacy to cope with cravings.

Key Findings

The study found significant increases in cocaine craving scores during the cocaine VR exposure compared to the neutral VR exposure. This suggests that VR is a potent tool for inducing cravings, potentially more effective than traditional cue-exposure methods. Notably, the relaxation procedure post-exposure helped return craving and emotional states to baseline levels, highlighting its therapeutic potential.

The findings of this study pave the way for innovative treatments in CUD. By providing a controlled, immersive environment, VR can enhance cue-exposure therapy’s effectiveness, making it a promising tool for both research and clinical applications. The ability to tailor VR scenarios to individual needs and monitor real-time reactions offers a personalized approach to addiction therapy.

Future Directions

While this study is a significant step forward, further research is needed to compare the efficacy of VR-based cue-exposure with non-VR methods and explore its long-term benefits in addiction treatment. The integration of VR in therapeutic settings could revolutionize how we approach addiction, providing more engaging, effective, and tailored treatment options for those struggling with CUD.

Conclusion

The feasibility study conducted by Lehoux et al. demonstrates the promising potential of VR in addiction therapy. By effectively inducing cocaine cravings and providing therapeutic relief through relaxation techniques, VR could become a vital component of modern addiction treatment strategies. As technology advances, the scope for VR in clinical settings continues to expand, offering new hope for individuals battling addiction.

This study marks a pivotal moment in addiction research, showcasing how innovative technologies can be harnessed to improve therapeutic outcomes. The intersection of VR and addiction therapy holds great promise, potentially transforming lives through enhanced treatment methodologies.

For more detailed information, you can access the full study here​​.

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Increasing Access to Essential Treatment

The opioid crisis has led to changes in federal policy aimed at making it easier for doctors to prescribe buprenorphine by removing specialized training requirements and lifting patient limits. Despite these changes, there is still a large gap between the number of people who need buprenorphine and the number who receive it in primary care settings. This study surveyed a representative sample of adults across the country to understand public awareness and attitudes toward receiving opioid addiction treatment from their primary care doctor.

Key Findings

The survey included 1,234 respondents from various backgrounds:

• 56.5% were female, and 43.5% were male
• 11.5% identified as Black, 15.2% as Hispanic or Latino, 68.4% as White, and 4.8% as other or multi-racial

The results showed that a majority of respondents (61.4%) did not know that primary care doctors could prescribe buprenorphine, and 13.3% incorrectly believed that they could not. However, there was strong support for primary care doctors providing opioid addiction treatment, with 53.9% agreeing and 24.9% strongly agreeing that they should.

Comfort with Treatment from Primary Care Doctors

The study also looked at how comfortable people would feel seeking or referring others to their primary care doctor for buprenorphine treatment. Among those who had used opioids:

• 50.6% said they would be very comfortable seeking treatment from their primary care doctor
• 30.7% said they would be somewhat comfortable

Among those who had not used opioids:

• 31.9% said they would be very comfortable referring someone to their primary care doctor for treatment
• 42.0% said they would be somewhat comfortable

Implications and Future Directions

Dr. del Pozo and his team emphasize that increasing public knowledge about the availability of buprenorphine from primary care doctors is essential for expanding access to this life-saving treatment. With around 209,000 primary care doctors across the United States, the healthcare system has a significant opportunity to improve the reach and effectiveness of opioid addiction treatment.

The study highlights the importance of educational campaigns and support for primary care doctors to encourage them to offer buprenorphine treatment. As the fight against the opioid epidemic continues, the role of primary care in providing accessible and comprehensive treatment options will be crucial.

This important research shows the untapped potential of primary care doctors in addressing the opioid crisis with buprenorphine treatment. By raising public awareness and providing support to doctors, the healthcare system can make significant progress in reducing overdose deaths and improving the lives of people with opioid addiction.

For more details, read the full study published in JAMA Network Open here.

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Mallinckrodt’s Rise and Strategies

From 2006 to 2012, Mallinckrodt dominated the US opioid market, selling nearly 40% of all opioid pills. Despite facing minimal public scrutiny compared to Purdue Pharma, Mallinckrodt’s operations had a profound impact on the opioid crisis. Their baby blue 30 mg oxycodone tablets, marked with “M30,” became so ubiquitous that counterfeits containing fentanyl still plague the streets today.

Despite legal challenges and two bankruptcy filings, Mallinckrodt has continued its operations. The company was ordered to pay $1.7 billion for misleading marketing practices but largely avoided full payment. The internal documents, made public, reveal a sophisticated strategy to influence doctors and shape the discourse around opioid use.

A Coordinated Effort to Influence

Mallinckrodt’s internal documents reveal a variety of tactics designed to increase opioid sales. These included designing continuing medical education (CME) courses, recruiting physicians as influencers, and planting articles in scientific journals. These efforts were aimed at portraying opioids as essential for both acute and chronic pain management, despite the growing addiction crisis.

Contracts with nearly 900 physicians and medical education companies show the extent of Mallinckrodt’s efforts to mold medical opinions. These contracts, totaling millions of dollars, aimed to position extended-release opioids like Exalgo and Xartemis as innovations in pain management. They also worked to mitigate concerns about addiction by promoting concepts like “pseudoaddiction,” where patients’ need for higher doses was framed as a symptom of under-treatment rather than addiction.

Manipulating Medical Education and Opinion

A significant part of Mallinckrodt’s strategy involved creating and funding CME programs. For example, the “Remedies: Focus on Opioid Tolerance” program aimed to educate 10,000 physicians, eventually expanding to reach over 88,000 prescribers. These programs were designed to present Mallinckrodt’s products favorably while downplaying the risks associated with opioid use.

Key opinion leaders (KOLs) played a crucial role in this strategy. Physicians like Michael Brennan and Charles Argoff, who received substantial payments from Mallinckrodt, were instrumental in disseminating the company’s messages. These KOLs helped to normalize the use of high-dose opioids and to frame concerns about addiction as irrational fears or “opioid-phobia.”

Ghostwriting and Publication Planning

Mallinckrodt also engaged in ghostwriting and publication planning, strategically placing articles in medical journals to support their products. Contracts with medical education companies like MedLogix ensured that the company’s preferred narratives were widely disseminated. These ghostwritten articles often presented extended-release opioids as safer alternatives, despite a lack of supporting evidence.

One notable concept promoted by Mallinckrodt was “chronification,” the idea that untreated acute pain leads to chronic pain, which supposedly justified early and aggressive opioid treatment. This concept was featured in review articles and CME programs, further entrenching the use of opioids in pain management.

The Aftermath and Continuing Impact

Despite the scrutiny and legal battles, Mallinckrodt remains a significant player in the opioid market. In 2023, the company reported $262 million in opioid sales, a 25% increase from the previous year. The release of these documents has provided invaluable insight into the corporate strategies that contributed to the opioid crisis.

The tactics revealed in Mallinckrodt’s internal documents highlight the broader issue of pharmaceutical influence on medical practice. By understanding these strategies, we can better address the root causes of the opioid epidemic and develop more effective policies to prevent similar crises in the future.

Conclusion

Mallinckrodt’s story is a stark reminder of the lengths to which pharmaceutical companies will go to protect and expand their market share, often at the expense of public health. The release of these documents underscores the need for greater transparency and accountability in the pharmaceutical industry. As we continue to grapple with the fallout from the opioid crisis, the lessons learned from Mallinckrodt’s playbook will be crucial in preventing future public health disasters.

Source and Authors

This article is based on an in-depth essay published in BMJ by Sergio Sismondo, a professor of Philosophy at Queen’s University in Ontario, Canada, and Maud Bernisson from the Institute for Science in Society at Radboud University, Nijmegen, Netherlands. Sismondo and Bernisson have meticulously analyzed nearly 900 contracts from the 1.3 million internal documents released by Mallinckrodt, revealing the extensive tactics used by the company to shape medical and scientific opinions.

Find More

1. Synthetic Opioids: Crisis 2.0
2. Opioid Overdose Risks
3. First Aid for Opioid Overdose

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Cannabis Use on the Rise

With the changing legal landscape surrounding cannabis, its use has become increasingly common. The study analyzed data from 175,734 patients who visited primary care clinics within the UCLA health system from January 2021 to May 2023. The results revealed that 17% of these patients reported using cannabis in the past three months. Among these users, 34.7% were identified as being at moderate to high risk for cannabis use disorder (CUD), a condition characterized by the problematic use of cannabis leading to significant impairment or distress.

Demographics and Patterns of Use

The study found notable differences in cannabis use across various demographic groups:

• Age: Younger patients (18-29 years) reported the highest prevalence of use at 31%, while those aged 60 and older reported the lowest at 8.5%.
• Sex: Male patients were more likely to use cannabis (20%) compared to female patients (14.7%).
• Socioeconomic Status: Interestingly, patients from the most disadvantaged neighborhoods had a lower prevalence of cannabis use (13.8%) compared to those from more affluent areas (17.4%). However, the risk for CUD was higher among patients from the most disadvantaged neighborhoods.

Modes and Reasons for Use

The study also explored the modes of cannabis use and the reasons behind it. The most common modes of use included edibles (61.6%), smoking (51.7%), and vaporizing (29%).

Patients reported using cannabis for various reasons, with the majority indicating they used it to manage health-related symptoms rather than strictly for recreational purposes:

• Sleep: 56% used cannabis to aid sleep.
• Stress: 50.2% used it to manage stress.
• Pain: 36.5% used it for pain relief, including nonspecific pain, muscle spasms, headaches, and arthritis.
• Mental Health: Many patients reported using cannabis for mental health symptoms, such as anxiety (36.3%) and depression (17.3%).

Implications for Primary Care

Given the high prevalence of cannabis use and the significant proportion of users at risk for CUD, the study underscores the need for routine cannabis screening in primary care settings. Screening can help clinicians identify patients who might benefit from early interventions to prevent the development of CUD and provide better guidance on the safe use of cannabis, especially for medical purposes.

Looking Forward

This study provides a valuable foundation for future research and healthcare policy. By understanding the patterns and reasons for cannabis use among primary care patients, healthcare providers can better address the needs of their patients and potentially mitigate the risks associated with cannabis use. The integration of routine cannabis screening in primary care could be a crucial step in enhancing patient care and ensuring the safe and effective use of cannabis.

For further details and in-depth analysis, you can access the full study in JAMA Network Open here.

Find More

1. Cannabis in Germany: From Outlaw to Legal High
2. Cannabis Hyperemesis Syndrome
3. Marijuana and Lung Health

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The research team, led by Katie Witkiewitz, Director of the Center on Alcohol, Substance Use, and Addictions (CASAA), includes UNM alumna and McLean Hospital/Harvard Medical School Clinical Psychology Intern Victoria Votaw, and Psychology Doctoral Students Felicia Tuchman and Hanna Hebden. Their study, “Examining cocaine use reductions and long-term outcomes in two clinical trials of continuing care for cocaine dependence,” was recently published in the Journal of Substance Use & Addiction Treatment.

Building on previous research by UNM alumnus and Yale School of Medicine Assistant Professor of Psychiatry Corey Roos, Witkiewitz and her team have taken strides to validate non-abstinent recovery methods for substance misuse.

Non-abstinent recovery approaches are crucial but often under-recognized in addiction treatment. Votaw believes that one of the significant motivations for this research is the lack of FDA-approved medications for cocaine use disorder (CUD). Unlike alcohol use disorder and opioid use disorder, which have FDA-approved treatments, the field of CUD treatment has seen a push towards considering non-abstinent endpoints that are sensitive to change.

Supported by over $1.4 million from the National Institute on Alcohol Abuse and Alcoholism, the UNM team analyzed clinical trials of continuing care for CUD. One key treatment examined was contingency management, a highly effective method targeting engagement in treatment without requiring complete abstinence. According to Witkiewitz, the study also illustrates that targeting engagement can lead to quality of life improvements without requiring complete abstinence. Many previous contingency management studies have primarily focused on incentivizing abstinence.

The study aimed to demonstrate the viability of non-abstinent recovery for CUD and provide potential FDA endpoints for future medication trials. Research indicates that reductions in cocaine use, even short of abstinence, can lead to significant improvements in functioning and quality of life.

The clinical trials showed that reducing cocaine use to one to four days per month predicted sustained reductions over 24 months. This finding challenges the notion that any drug use is a failure, supporting the effectiveness of harm reduction strategies.

In a year, 62% of high-frequency users (5+ days/month) achieved abstinence, while 21% reduced to low-frequency use (1–4 days/month), and 12.2% went from low-frequency use to abstinence.

Examining who can achieve a successful non-abstinent outcome is important on the patient level, but I think more at the structural level. There are things that treatment providers can do that make people more likely to achieve success. If somebody is trying to reduce to a non-abstinent goal in a very abstinence-oriented treatment environment, what’s that experience going to be like for the patient? Will they feel supported?

Victoria Votaw

The contingency management aspect is vital, as it reinforces positive behavior changes without penalizing slip-ups. This research supports the broader acceptance of non-abstinent recovery as a viable endpoint for CUD, offering a more flexible and patient-centered approach to addiction treatment.

I think that’s the ultimate goal. I mean, for so long, providers were really, really focused on abstinence because there wasn’t data showing alternatives. Now you can target reductions in use, which might be more appealing to some people.

Katie Witkiewitz

Sources

1. Examining cocaine use reductions and long-term outcomes in two clinical trials of continuing care for cocaine dependence
2. Researchers investigate non-abstinent recovery for people with cocaine use disorder

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Study Overview

The paper Are you tripping comfortably? Investigating the relationship between harm reduction and the psychedelic experience by Madelene Palmer and Olivia M. Maynard explores the practices and perceptions of harm reduction among recreational psychedelic users.

The study employed a mixed methods approach, utilizing an online survey to gather both quantitative and qualitative data from 163 participants. Participants were asked about their first and most recent psychedelic experiences, focusing on the harm reduction practices they employed. Qualitative data were collected through open-ended questions.

ANOVA stands for Analysis of Variance, a statistical method used to compare means among three or more groups to determine if there are any statistically significant differences between them. In the context of the study ANOVA was used to analyze the data and assess the differences in harm reduction practices and their effects on psychedelic experiences.

In the study, ANOVA was used to:

• Compare Harm Reduction Scores: Determine whether there were significant differences in the use of harm reduction practices between the first and most recent psychedelic experiences.
• Examine Relationships: Assess the association between harm reduction practices and outcomes such as emotional breakthrough (EBI scores) and challenging experiences (CEQ scores).

The study found a significant main effect of occasion (F (1,162) = 28.32, p < 0.001), indicating that harm reduction practices were more frequently used in participants’ most recent experiences compared to their first. Additionally, the interaction between time and occasion was significant, suggesting that specific harm reduction practices varied across different stages (before, during, and after the psychedelic experience).

By using ANOVA, the researchers could robustly test their hypotheses and draw meaningful conclusions about the evolution and impact of harm reduction practices among psychedelic users.

Key Findings: Importance of Harm Reduction

Analysis revealed a significant increase in harm reduction practices from participants’ first to their most recent experiences. Notably, these practices correlated with more positive experiences and fewer adverse effects, particularly during initial use. Common practices include:

• Ensuring familiarity and comfort with surroundings.
• Measuring and testing the dose of the substance.
• Obtaining psychedelics from reputable sources.
• Engaging in mindfulness practices like meditation.

Experience-Based Insights

Qualitative responses highlighted profound, often life-changing benefits from psychedelic experiences when proper harm reduction strategies were employed. Many users emphasized the critical nature of “set and setting” — a well-prepared mental state and a safe, comfortable environment. Experienced users reported evolving their approaches over time, indicating a learning curve that enhanced safety and overall experience quality.

Quantitative Findings: Using ANOVA, the study found that harm reduction practices were positively associated with EBI scores and negatively associated with CEQ scores, particularly during the first psychedelic experience. This suggests that effective harm reduction can enhance positive outcomes and reduce negative experiences.

Qualitative Insights:

1. Profound Positive Experiences: Participants often described transformative and life-enhancing experiences facilitated by psychedelics.
2. Importance of the Drug: The type and source of the psychedelic substance significantly influenced the perceived necessity and effectiveness of harm reduction practices.
3. Set and Setting: The psychological mindset (set) and physical environment (setting) were critical in shaping the psychedelic experience. Participants emphasized creating a safe, calm space and preparing mentally and emotionally for the trip.

Strengths and Limitations

The study provides a detailed characterization of harm reduction practices among psychedelic users. The mixed methods approach offers both quantitative and qualitative insights.

The sample may not be representative of all psychedelic users, as participants were recruited from specific forums and communities. Self-reported data may be subject to recall bias, particularly for the first psychedelic experience.

Conclusions and Future Directions

The study suggests a gap in harm reduction application among novice users, likely due to unawareness or unplanned, spontaneous use scenarios. This highlights the need for targeted educational efforts that inform new users about effective harm reduction techniques to ensure safer and more positive experiences.

The article underscores the importance of harm reduction practices in enhancing the safety and positive outcomes of psychedelic experiences. By increasing awareness and providing tailored advice, it is possible to reduce risks and maximize the therapeutic and transformative potential of psychedelics.

Future research should focus on refining harm reduction practices and exploring their effectiveness across different user demographics and settings. Additionally, understanding the role of challenging experiences and their potential for positive transformation is essential.

Additional Materials

1. Trip Sitter. Basics and Directions
2. Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development
3. Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice

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