Some commentaries that receive sufficient interest to merit revision will be reissued as a succinct statement that incorporates highlights from the subsequent discussion and/or follow-up commentaries (i.e., highlights of related commentaries). These new summaries are designed to summarize the main discussion in a simple, concise manner. The Keep It Simple Stupid approach is affectionately referred to as the "KISS version" and will include a trackback to the original commentary or commentaries and any relevant discussion for those who would like to read the full version or retrace the original discussion(s). The KISS versions are provided as a convenience to those who don't wish to read through the entire original posting(s) and subsequent replies that generated the proverbial 'bottom line.' This should be especially useful for the 'speed surfers' who peruse a lot of material, very quickly on the Internet and help viewers to determine which commentaries merit slowing down to ponder the discussion. Some commentaries that address interrelated topics (often interspersed with unrelated commentaries) will be consolidated into a single KISS version as will select commentaries that have later podcasts appended.
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Perhaps this KISS announcement will merit a KISS itself.
This update lists new material on the Addiction Science Network (ASNet) website including the ASNet Discussion Forum. Beginning with “Theories of Addiction,” podcasts will be available only as downloads for playing on your mp3 player. We thank Podomatic.com for providing storage for the earlier streaming audios which remain available from their website. Click on the links below for direct feed to the new material.
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This concludes update ASNet12J10.
Most of the adverse effects associated with overdose from opioid-based medications could easily be prevented or rectified by simply making naloxone more widely available. It seems as if the medical establish is afraid that letting people know that their overdose can be quickly and effectively reversed will give patients a green light to abuse their opioid medication. Undoubtedly it will for some, but for most it should not. And there is no doubt that it would save thousands of lives!
Naloxone hydrochloride (Narcan) is a selective narcotic antagonist that rapidly and effectively reverses the effects of opioids including those associated with overdose (e.g., respiratory depression). As long as the circulatory system has not collapsed and the naloxone is able to reach the brain, it binds preferentially to opiate receptors blocking the effects of heroin, morphine, oxycodone, methadone, hydromorphone, fentanyl, opium, L-alpha-acetylmethadol, well, you get the idea, opioids.
Naloxone has no effects in people not receiving opioids. It simply blocks the effects of licit and illicit opioids regardless of who or why the drug was administered. (Yes, I know about endogenous opioid peptides [EOPs], wrote a paper or two involving those neuromodulators myself, but the effects of disrupting the EOPs are disappointing for we neuroscientists who were hoping back in the 1980s they would hold the key to everything from overeating to some forms of mental illness.) Naloxone is virtually unnoticeable in someone who has not been receiving opioids and has a very wide margin of safety for dosing in humans.
It’s shame on the medical establishment for withholding this critical information from the public. Should the medical establish and individual physicians be held responsible for these needless deaths? Is it THEIR decision to make, who will live or die based on the availability of this life-saving drug? Why aren’t patient-advocacy groups confronting the medical establishment, lobbying more strongly and unrelentingly for take-home Narcan?
Naloxone has been around for a long time. In fact, my first research using this compound was in 1975 and my first publication with it was in 1977 when I (along with Prof. Larry D. Reid) demonstrated that naloxone hydrochloride effectively and rapidly blocked morphine’s facilitatory action on electrical brain stimulation reward. I continued using naloxone in many of my experiments for the next two decades.
There are certain precautions that must be exercised when using naloxone, and proper medical training is strongly advised. (Self-instruction cards are included in some naloxone rescue kits so that more people can be reached with this life-saving treatment, although professional training is always advisable.) Two of the most important areas for concern involve the precipitation of intense withdrawal reactions and the short half-life of naloxone.
On-site resuscitation with naloxone (Narcan) is not an excuse to avoid immediate professional medical attention. For those who are concerned about getting into ‘trouble’ for their heroin overdose, consider how much trouble you or your friend will be in if you’re dead! Furthermore, naloxone is not a CSA/DEA controlled substance nor is having an illicit drug in your bloodstream an illegal act to the best of my knowledge (but then, I’m not an attorney, so I’ll “rest my case” with the first ‘argument’ – you’d be in more trouble if you’re dead).
New York State is to be commended for being among about a dozen U.S. states and several European and Asian countries where naloxone rescue kits are legally available. Unfortunately, while trying to 'fly-under-the-radar' of possible adverse public opinion, New York and other states make it difficult to find information about this important program. The public needs better education about the nature of drug addiction (and while we're at it, so do America's physicians!), and politicians need the proverbial fire lit beneath their butts to get them moving and starting to change attitudes about harm reduction. It's ironic perhaps to some people that the "rescue kits" are available mostly to illicit drug users, and the aging baby-boomers being increasingly prescribed opioid-based medications do not usually have access to this program. Well, at least it seems somewhat ironic to this baby-boomer (e.g., we are the least likely to "abuse" the "kits" in any sense of the word).
I have been advocating take-home naloxone for years as part of a harm-reduction strategy for illicit opioid users, but now there's a whole new group (and generation) that could benefit from this policy as well -- patients prescribed opioid-based medication who are sometimes overdose victims. This commentary is focused on this 'new' group, although my position on naloxone as part of a comprehensive harm-reduction strategy remains ever strong. Perhaps there should be a warning to politicians regarding this issue like the warnings that appear on the opioid medication bottles -- caution: prescription opioid-users vote!
Finally, I just have to state the obvious because I know that this is going to escape the attention of too many people. It's not just about accidental overdose in the person prescribed the opioid-based medication; it's also about the grandchildren who despite ones best efforts find and play with the pills and about the little puppies who quickly grab and devour anything accidentally spilled on the floor by fumbling old hands as if it were a tasty treat. THESE are the other potential victims, perhaps even more deserving of our concern!
This information is not intended as medical advice nor is it a substitute for proper medical training. It is strictly intended to bring this topic to the forefront of discussion and to argue for the widespread availability of take-home naloxone. Write your state and federal representatives in support of this program and acquire and learn to properly use naloxone rescue kits whenever practical (cost estimated under $10).
A central theme that I’ve been teaching in my courses on drug addiction for the past 30 years is that “drug addiction is an equally opportunity affliction.” Unfortunately, this is ‘news’ to too many of my advanced undergraduate psychology students. After just a few weeks of examining the diversity of case studies and then provided with a simple model that unifies the many ‘paths to addiction’ to a single common ‘cause,’ students become excited about the ‘recent progress’ in understanding addiction and fully expect that neuroscientists will find ‘the cure’ in short order. That is, now having recognized what really drives addiction, shouldn’t scientists be able to quickly resolve this disorder which extracts such a horrific toll on the individual, on their friends and families, and on society?
The message is what we (i.e., basic scientists) have known for years, but popular media, many clinicians, and even too many misguided drug-addiction specialists have managed to keep the pond muddied by stirring up the waters with popular discourse and dramatic portrayals played out in endless psychodrama that captivates audiences every time across time. In my primary drug addiction course alone I’ve taught nearly 3,000 400-level students during the past 26 years at the University at Buffalo. Surely there should be a multiplicative effect of my training as they go out and spread-the-word as the next generation physicians, clinical psychologists, counselors, sociologists, and even politicians. And there’s the scores of other professors just like me, some teaching this simple theme even longer. But at last, popular misconceptions like superstitions are just too damn hard to kill off. And “today’s insight” will probably remain a “new discovery” for another 25 years as this professor retires and hopefully the next one caries the torch educating and enlightening thousands more during his/her tenure as a university professor. The more things change, the more they stay the same.
The psychobiological model (Bozarth, 1990) that I teach is rather simple; it’s based largely on what is termed the “exposure model of addiction.” Basically, exposure to an addictive substance and the subsequent effect on brain reward and motivation pathways leads to addiction for many people. The varieties of personalities and subcultures that become addicted is also a product of exposure but with the added feature of psychosocial factors which govern such variables as (1) who has access to the drug, (2) who will experiment with the drug, (3) the cost and purity of the drug, (4) which drug or drugs are popular and how are they administered (e.g., “crack” cocaine is probably more addictive in some respects than is powered cocaine because of the routes they are administered despite being two forms of the same active chemical), and (5) who will find sufficient extrinsic rewards in the culture of their drug-taking behavior (e.g., peers who encourage actual drug taking and its ancillary behaviors) and thus continue their drug-taking behavior long enough for the critical neuroadaptive effects to occur which are ultimately responsible for an addiction. This is where the psychological and sociological variables exert an important influence on who is and is not likely to ultimately become an addict—during the early acquisition stage of developing an addiction. There is plenty of room for popular psychosocial and cultural variables to play a role in addiction and to present cyclic variations in “types” of people who become addicts; the role is just much different that commonly perceived. There are also high-risk groups, some genetically predisposed to experience an exceptionally strong motivating effect from their early drug-use experience and there are co-morbid disorders which may introduce a variety of secondary influences on the drug’s pharmacological effects (e.g., ADHD?, psychological depression?). Nonetheless, the “exposure model” provides a point of convergence for the sundry personalities and subcultures that find the allure of the drug irresistible. The drug is guilty; the addict makes one critical mistake—they sustain their initial use of the ‘wrong’ drug sufficiently long for the neurochemical sequel to develop which leads to addiction.
The popular media, from talk shows to Hollywood movies, will probably never get on the page and portray the real story behind addiction. They will continue to promulgate the popular myths about addiction finding better dramatic material in the cases that admittedly have an interesting story to tell about why they began their illicit substance use, while obscuring the fact that it wasn’t actually the perverted “Uncle Albert” but the drug which is the responsible agent for the addiction. The truth simply doesn’t make a good story. Mary sexually abused by her grandfather, Tom bullied as a child, Nancy stressed out by her failed sex-change surgery are much more entertaining to watch and read about, and they elicit much more empathy from viewers who can relate to various aspects of the anguish that leads to their addiction. Watching young people experiencing the intense rush produced by “crack” cocaine, bouncing from stranger to stranger on the street looking for money for the next fix to feed their cocaine craving has the home audience chanting in unison “they get what they deserve” and then quickly turning to another program. The market writes the message.
During Alan Leshner‘s tenure as director of the National Institute on Drug Abuse (1994-2001), “addiction is a brain disease” became the mantra of the Institute. Whether it’s a “disease, disorder, or syndrome” may be debatable, but it’s certainly a “brain” something unless one wishes to accept pixie dust as the mechanism behind drives and motivations, lusts and desires. The “patterns” are easy to explain—simply examine the psychological and social-cultural variables that initiate and sustain the period of early drug-use; there your personality types, sociological sub-groups and other patterns will emerge, based on who tries the drug not on why they try the drug, no requisite personality types or pixie dust required. The ‘chemicals’ in the drug interact with the ‘chemicals’ of the brain—it’s that simple.
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