Summary: Despite a decline in opioid prescriptions, the opioid crisis continues. Opioid use disorder (OUD) and deaths due to opioid overdose continue to increase. Thus, researchers say that there is a need to develop a better understanding of opioid dependence and avoid oversimplification of the problem. So though an increase in opioid prescriptions initially fueled the crisis, later, other factors came into play, like pill mills and an increased supply of illegally produced opioids. 

The opioid crisis is not new, but it is not showing any signs of fading despite the best efforts of regulatory agencies and medical practitioners. What is worrisome is the upward trend of opioid overdose-related deaths, despite a significant decline in opioid prescriptions in the last few years. In addition, it appears that many are now procuring and using prescription opioids produced illicitly. 

Researchers think that if we want to counter this crisis, we need to understand the complex nature of the opioid crisis. Things are not as simple as they might appear. This crisis is not fueled much by opioid prescriptions by doctors to manage chronic pain. Instead, there are other factors like pill mills and “unscrupulous” physicians fueling opioid use disorder (OUD). This pathway that is fueling OUD exists outside the domain of chronic pain management. 

Though there are indeed many faces of the opioid crisis, and it is among the most complex health crisis causing physical and psychiatric health issues. Still, it is also worth understanding that the drug landscape is continually changing. Therefore, what researchers warn is against the oversimplification of the problem. 

For example, saying that the epidemic is solely fueled by opioids prescribed to manage chronic pain is just an oversimplification. On the contrary, studies show that when opioids are prescribed for managing chronic pain, very few patients abuse these drugs. Hence, opioids prescribed by doctors to manage chronic pain do not contribute much to OUD.

Similarly, initially, this factor played a role in OUD development since prescription drugs were cheaper options. However, this factor is not relevant anymore. Though pill mills continue to contribute to the crisis, they are not the only source.

It is true that initially, opioid prescription played a significant role in the opioid epidemic. The epidemic had a humble beginning, as the doctors wanted to help their patients living with chronic pain. Thus, they started prescribing opioids to many patients. However, soon opioid demand rose, and many started procuring these drugs from the illicit market. Due to high demand, the market got filled with illegal drugs. This also affected the market for illicit drugs as it shifted from heroin from Asia to illicitly produced fentanyl in Latin America.

However, researchers say we cannot blame pill mills and unscrupulous physicians alone. Many hospitals continue to prescribe opioids even for conditions with little benefit from opioid prescriptions. 

Since the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, opioid prescriptions have fallen. Nonetheless, opioid prescriptions remain relatively high in the US compared to other nations worldwide. In addition, studies now confirm that 90% of those living with OUD often use these drugs for non-medical reasons.

Though studies suggest that very few people prescribed opioids for chronic pain will ever develop OUD, this is still a significant number. Moreover, studies show that the number of people older than 50 seeking treatment for OUD has continuously increased. People of this age group are more likely to source opioids from physicians.

Similarly, it is still poorly understood why some individuals are more likely to develop OUD. Nonetheless, researchers think that there is no single explanation. Most of those who develop OUD are individuals who already have other psychiatric comorbidities apart from chronic pain. Thus, this group of people is more likely to develop OUD. Consequently, they not only keep using prescription opioids but are also pretty likely to buy illicit drugs.

To sum up, the researcher says that though specific techniques like using electronic health record notification and motivational interviewing along with opioid dependence treatment  may help reduce the risk of OUD, much work still has to be done to understand the causes of OUD.

It is our mission to bring real hope and transformational change to patients who would otherwise be consigned to a lifetime of medications for opioid addiction treatment, doctor’s visits, and suffering. We expose misaligned incentives and return the power of health to the individual. We believe empowered individuals change their communities. We use a combination of lifestyle intervention, medication management, and emerging scientific research to help our patients.  When you are ready or have questions, reach out.

Medical Disclaimer: Keep in mind that the content provided is not direct medical advice for patient care, but is provided for thoughtful discussion.

Summary: Connecticut legalized recreational marijuana in June 2021; by October, there were 39 reports of overdose. However, doctors now believe that fentanyl-laced marijuana caused these cases of acute toxicity. Although doctors could demonstrate fentanyl-laced marijuana in just one case, they know that fentanyl-laced drugs are pretty common. Moreover, the history of patients shows that 30 out of 39 had a history of opioid abuse. Thus, intentionally, or unintentionally, they were exposed to fentanyl. However, for legal reasons, they were hesitant to report the truth. Nevertheless, it is something that all users of legal marijuana must be aware of.

Marijuana is finally legal in many US states. People have been demanding to legalize marijuana for a long. There are many reasons for such a demand. After all, humans have used marijuana for ages, and despite some ill effects, it does not cause severe addiction or toxicity. Moreover, its health harms are well known to science. In short, it is a relatively safer substance of abuse and is of natural origin. But not only that as it also has some health benefits like pain reduction, managing gastrointestinal issues, and more.

 

Connecticut became the latest state to legalize marijuana in July 2021 finally. But then came the reports of severe intoxication with it. Within the three months of legalization, 39 reports of marijuana overdose were reported. However, the cases were not typical of marijuana overdose, and they benefited greatly from the naloxone dosage. Naloxone is mainly used to manage opioid overdose. This led experts to believe that people have misinformed doctors. Either intentionally or non-intentionally, they smoked fentanyl-laced marijuana. Moreover, testing of some samples confirmed the theory.

 

Recreational use of marijuana may be legal in some states. However, not everyone is going to use it for health conditions or responsibly. Many people addicted to street drugs and opioids are also likely to use marijuana. However, for many of them, marijuana fails to provide the kind of high they are looking for, and thus they might use marijuana laced with other drugs. In other cases, it may occur without users knowing about it. Some of the opioids are much cheaper to produce than growing marijuana. Thus, adding them to marijuana may help users achieve more substantial effects quickly.

 

Fentanyl-laced marijuana poses a significant health threat

One such opioid commonly mixed with various substances of abuse is fentanyl. It is a synthetic opioid. It is produced cheaply at the industrial scale and is readily available. Thus, it is often mixed with more expensive drugs like heroin, methamphetamine, cocaine, and more. This helps to produce addictive drugs cheaply. Unfortunately, however, many people unknowingly may use such drugs or fentanyl-laced marijuana.

 

However, here it is vital to understand that some addicted to opioids may do it intentionally. But, if they overdose on fentanyl, they are not likely to report it to avoid legal issues. Thus, they are more likely to inform only about marijuana use.

 

This kind of mixing is dangerous in many ways, as users are unaware of what they took. This also creates a problem for doctors treating drug overdose. Even if the users know that they have overdosed on fentanyl, they still avoid telling the truth. But doctors know that marijuana may cause acute toxicity but rarely causes severe issues like breathing problems or loss of consciousness, unlike fentanyl or other opioids.

 

Although in the Connecticut cases, experts could find fentanyl-laced marijuana in just one of the samples. Still, they have a firm reason to believe that most, if not all, of the cases, were due to fentanyl overdose. This is apparent in the history of users, as 30 out of 39 were known to have opioid abuse history. Additionally, doctors can judge based on the symptoms. Further, naloxone, a drug used to treat opioid overdose, could help in most cases.

 

Although not everyone believes the case of fentanyl-laced marijuana, experts warn that it is more common than many people realize. Fentanyl-laced drugs are pretty common, so why could fentanyl-laced marijuana not be possible?

 

Doctors warn that marijuana users be careful and aware of this, as fentanyl-laced marijuana or drugs may cause much more severe health effects. It is the common cause of unintentional drug overdose and death.

Summary: Chronic groin pain is a significant issue in those who have undergone surgery for an inguinal hernia. This often leads to patients blaming the mesh companies. It also causes prolonged distress and trauma to the patients. However, doctors often fail to treat such pains. Studies suggest that in many such instances, pain is due to some other underlying cause like low back pain or trauma, and only in small cases is it secondary to surgical intervention. Thus, doctors recommend careful history taking to identify the cause of this pain and suggest various treatments like Suboxone treatment. Additionally, experts also recommend exploring nontraditional treatments for chronic pain, like psychedelic-assisted psychotherapy.

 

In the annual meeting of the American Hernia Society, 2021, Doctor Brian P. Jacob discussed the significance of understanding chronic groin pain and finding its solution using innovative treatment methods.

 

Groin pain is a pretty common complaint among those living with inguinal hernia. Quite often, this hernia is treated using mesh repair. It is a relatively simple surgical procedure that provides instant relief in 70% of cases. However, experience shows that one-third of patients continue to experience pain. Quite often, they blame mesh for their continued pain, and doctors fail to understand the cause of such pain.

 

Dr. Jacob has multiple recommendations for surgeons and pain clinics for managing such pain. He also underlined the importance of understanding this pain. Since this continued pain after surgery is a source of significant distress. It makes patients quite angry, and they also go on blaming the mesh companies for their pain. Not only that, untreated patients undergo significant trauma, resulting in PTSD.

 

Surgeons must identify the cause of chronic pain

Dr. Jacob says that there are two sources of these chronic pain in those who had hernia surgery. The first and often overlooked cause of this chronic pain is some pre-existing condition in the patient, like a back issue or some other trauma. Unfortunately, doctors often fail to notice or identify these causes, and the patient continues to associate this pain with the surgery.

 

The second reason for such chronic pains is naturally the surgery itself, which means unintentional fault. Unfortunately, however, surgeons are often hesitant to accept that something has occurred due to the surgical procedure, and this negation only adds to the patient’s frustration.

 

There cannot be more frustrating for the patient than doctors failing to recognize the cause of pain. Thus, such patients have to tolerate this continuous chronic pain, and at the same time, they undergo severe emotional trauma. Worst in this situation is the fact that these patients largely remain untreated.

 

Thus, Dr. Jacob recommends that doctors accept that their patient is going through severe and chronic pain and focus on finding the solution. It is true that identifying the cause of such chronic pain is challenging. Nevertheless, they need to treat such patients. He particularly recommends focusing on alternative therapies

Alternative therapy for chronic groin pain

Dr. Jacob advocates exploring alternative treatments for chronic pain. This does not essentially mean supplements. It also means exploring uncommon approaches to pain management. The traditional way of pain management appears to mask the pain origins and provide temporary relief.

 

Unlike traditional painkillers or opioids, doctors must explore non-pharmacological therapies like meditation, mindfulness, yoga, pilates, and even psychotherapy. Dr. Jacob is also a proponent of psychedelic-assisted psychotherapy.

 

When it comes to psychedelic-assisted psychotherapy, this therapy mainly uses ketamine these days. Ketamine is proven to work, safe, and supported by many clinical studies. The results of ketamine-assisted psychotherapy are pretty promising.

 

However, Dr. Jacobs also favors exploring other ways of psychedelic-assisted psychotherapy. Among the other agents, psilocybin and MDMA are pretty promising. These medicines have excellent safety profiles and maybe even better than ketamine. Moreover, these therapies not only treat pain but also help overcome anxiety, depression, PTSD, and other severe mental health issues.

 

In short, Dr. Jacob strongly recommends taking a thorough history of patients with groin pains. The doctor should not assume that this pain is only due to an inguinal hernia. In many cases, other unidentified causes of groin pain remain undiagnosed. Additionally, in some cases, the cause of chronic pain could be a surgical procedure. In all these conditions, doctors must understand the patient’s pain and focus on treating chronic pain using various methods.

Summary: Exercise can help boost brain health in multiple ways. It may help by improving metabolic health and thus indirectly slowing down neurodegeneration. However, a new study now suggests that exercise can directly impact the brain as it can significantly boost neurotransmitters and growth factors. Thus, the study found that 30 days of workout can boost dopamine levels by 40% and BDNF levels by 60%. It means that training has immediate, mid-term, and long-term benefits for brain health. It can help prevent and manage neurodegenerative disorders more effectively than thought earlier.

A new study suggests that exercise could be the most effective way to prevent neurodegeneration. They found that exercise may boost many bioactive compounds in the brain and even boost neurotransmitters’ levels.

Experts have long believed that the rise of neurodegenerative diseases in the last few decades has a lot to do with lifestyle. After all, genetics cannot change in a few decades. Infectious diseases have also become less common. It appears that nutrition status has also improved over the decades.

So, what could be the cause of an increase in neurodegenerative diseases? It could be a rising concentration of environmental toxins, and some lifestyle issues like obesity, high-calorie intake, unbalanced diet, and lack of physical activity

The more researchers study the role of exercises in wellness, the more they are surprised. It appears that a high level of physical activity may be the best way to boost physical and mental health. The benefits of regular physical activity are innumerable.

Exercise may help in neurodegeneration in multiple ways

Experts have long known how exercise may help prevent neurodegeneration disease symptoms by boosting metabolism, improving energy metabolism, preventing mitochondrial dysfunction, lowering insulin resistance, and more.

However, new studies confirm that regular exercise can boost the level of specific bioactive compounds that help prevent neurodegeneration. Thus, the study found that just about 30 days of exercise, that is, voluntary wheel running by mice, could boost the levels of dopamine and BDNF (brain-derived neurotrophic factor).

Researchers were amazed to see that regular exercise could boost dopamine levels by as much as 40%. Which is more than many drugs can do. It means exercise may have greater benefit for mental health than certain pharmacological drugs in conditions like Parkinson’s. In fact, regular exercising along with expert guidance through telehealth can also help in addiction recovery eliminating the chances of relapse.

Earlier studies have proven that exercise can benefit significantly in Parkinson’s. However, those studies could not demonstrate how exercise helps and to what degree. It now appears that exercise has a more favorable impact on brain health than imagined earlier.

Moreover, this study found that the impact on exercise is felt several days after discontinuing it.

The same study found that 30 days of the exercise was enough to boost BDNF levels by 60%, which is significant. There are no known pharmacological drugs that can boost the level of this growth factor so much.

Researchers think that increased dopamine levels in the brain have short and mid-term benefits in Parkinson’s, while an increase in BDNF has long-term benefits. An increase in BDNF may help prevent further neurodegeneration and even boost regenerative processes.

Although this particular study focused on the benefits of Parkinson’s, researchers think that regular exercise may help in many neuropsychiatric disorders. For example, regular workout could be a perfect way to overcome anxiety and depression.

Since exercise can not only boost the levels of various neurotransmitters but can also enhance the concentration of growth factors, it is pretty likely that regular workout may significantly reduce the risk of other neurodegenerative disorders like age-related cognitive decline and dementia.

Summary: The prevalence of mental health issues has increased significantly in the last few decades. Finding mental health counseling support has been challenging in the US for many years. Psychologists and psychiatrists are not just taking new patients; waiting times are several months long. Moreover, it appears that the mental health care system was ill-prepared for multidimensional stressors like the coronavirus epidemic. The need for mental counseling increased significantly due to coronavirus-related stress. Thus, people are increasingly finding it difficult to find mental counseling support.

Getting timely brain health counseling has never been as difficult as these days. The delays are unbearably long. Thus, many people have to look for alternative ways to manage their health, like practicing yoga or seeking online advice.

Things are especially bad for those living in larger cities, where getting qualified mental health advice may take months. The Internet is full of stories of people who urgently need such support, yet they could not find any. For example, many need mental health counseling to overcome their grief. If they cannot find support immediately, things may become much worse. But it appears that no one is willing to accept new clients.

The coronavirus pandemic has made things worse

Though getting timely mental counseling was never easy in cities like Los Angeles, things have worsened lately. It appears that many more people are seeking help due to coronavirus, and there are just not enough qualified mental health care workers in the US.

Just take an example of Boston Medical Center, which started contacting parents of children who joined the waiting list in April 2021. Unfortunately, they had to wait for more than 10 months to get the help of a child psychiatrist.

The American Psychological Association (APA) recently surveyed and found enormous pressures on the psychologist workforce. The coronavirus pandemic has increased the demand for treating conditions like depressive disorder, anxiety, grief, sleep disorders, and substance abuse by as much as 50% in many instances.

In the survey conducted by APA, 62% of psychologists reported an increase in patient referrals since the beginning of the coronavirus pandemic. In addition, they reported an almost 40% increase in workload. Thus, 65% said that they have no capacity for new patients.

APA, which represents 133,000 psychologists, is not surprised by these issues. They have long predicted these things.

APA long predicted the deficit of mental health care workers

An article was published in the APA’s journal way back in 2020 when the association said that the present system is not ready to handle the upsurge in mental health issues caused by multidimensional stressors like covid-19.

The reason why it is so hard to find a mental health counselor

Mental health counselors could be psychologists or people trained in managing mental health issues. They can generally provide various advice and non-pharmacological means of managing mental health issues like telehealth. However, these people do not prescribe medical drugs. Then there are psychiatrists, who would often prescribe medications to address mental issues. In addition, people seek help from psychiatrists for more severe mental problems like major depression or even schizophrenia.

There appears to be a deficit of psychologists and psychiatrists in the US, which is the main reason why people have to wait so long to get help. The number of people living with mental health has increased significantly during the last few decades. But, the present health system, which was created after World War two, failed to foresee this upsurge in mental health problems.

An even more severe problem is finding narrow specialists. For example, it is highly challenging to find a specialist for mental problems in children. Similarly, very few psychiatrists understand the requirements of ethnic minorities in the US. Thus, finding a psychiatrist with experience in treating black people may be tricky if you are black.

To conclude, the US is in the middle of a mental health epidemic, and there is an urgent need to carry out reforms to the healthcare system. However, it is not something that can be done overnight. Till then, most people are left on their own to find a brain health counselor.

Summary: Substance abuse or addiction is the leading cause of mortality among young adults. It is a highly preventable condition. However, with high relapse rates, modern addiction treatment is far from satisfactory. Thus, there is a need to find more effective ways of addiction treatment. In the retrograde study, researchers found that people with brain lesions of certain parts of the brain were able to quit smoking. They found that this was associated with some changes in brain circuits. They think that in the future, these findings may help treat addiction. Doctors can identify and then alter the activity of these brain circuits by using different non-invasive methods.

Substance abuse is the leading cause of death among young adults. It results in several hundred thousand deaths in the US alone each year. Most of these deaths could be prevented through effective addiction treatment.

However, despite years of research, addiction treatment is far from satisfactory, with high relapse rates. The truth is that most people fail to benefit from addiction treatment.

The problem with modern addiction treatments is that they do not focus on exact brain areas. Instead, doctors use different addiction treatment methods like nicotine replacement therapy to reduce nicotine cravings. Similarly, they might use drugs to reduce cravings for various other substances.

However, science also knows that brains are wired quite differently in some individuals, and they do not become addicted to substances, even after prolonged substance use.

Not only that, researchers have found that many people can get rid of their addiction or make a complete recovery after a stroke or specific brain injuries. Again, this underlines the importance of specific brain pathways or circuits in substance abuse.

Suppose science could clearly understand the role of various brain centers, and circuits in addiction. In that case, they might be able to create brain lesions through surgery or use non-invasive methods to stimulate specific brain circuits and thus help people eliminate their addictions.

A new study could confirm the role of brain circuits in addiction

This new study is a step forward in addiction treatment. Researchers could identify the connection between certain brain circuits and addiction. This study differs in the way that, unlike early studies focusing on certain brain centers, this study focused on specific brain circuits.

It means that stimulating the different parts of the brain may help get rid of addiction. However, this means that the focus must be on modulating brain circuits, not specific brain centers.
This particular study is a retrograde study. Researchers found that some individuals could quit smoking after a stroke or other brain lesions. However, they understood that this must be related to disruptions in certain brain circuits.

In the study, researchers found that although all the people who could get rid of their addiction had lesions at different locations, these locations were part of specific brain circuits. It means that it is not vital to alter the working of specific brain centers to treat addiction. Instead, doctors need to focus on specific brain circuits.

There could be many ways to alter these brain circuits, like creating lesions through surgery. However, researchers are more interested in non-invasive methods like deep brain stimulation, MRI-guided ultrasound, and transcranial magnetic stimulation. These non-invasive methods are pretty safe and can help alter brain circuits.

Researchers think they are on the right path, as understanding the role of brain circuits in various disorders can also help treat various neurological conditions. For example, it may help manage tremors associated with different brain disorders.

Researchers say that there are still some limitations to their findings. This present study mainly focused on nicotine addiction in those who suffered brain lesions. They are unsure if similar kinds of brain circuits are involved in other types of addictions like alcohol.

Additionally, these are retrograde studies in those who suffered from brain lesions due to some disease. However, researchers would need to find ways of modulating these brain circuits safely in healthy adults, to help them overcome addiction.