Summary: Recently, the UK MHRA has updated its guidelines, making it quite difficult for doctors to prescribe valproate to women and men below the age of 55. Valproate is often used to treat epilepsy, bipolar disorder, and sometimes even migraine. This update has been introduced due to concerns regarding continued in-utero exposure to the drug to a small number of newborns each year.

Experts are raising concerns regarding the safety of one of the commonly used anti-seizure drugs, and UK guidelines have been updated prohibiting the prescription of valproate to men or women younger than 55 years of age. So, should the US also consider updating its guidelines?

UK Medicines and Healthcare Products Regulatory Agency (MHRA) has issued new guidance that bans the use of valproate in male and female patients below the age of 55 unless two independent experts consider it necessary.

Valproate is not just used to manage seizures or epilepsy. It is also used to manage bipolar disorder. Additionally, it may be sometimes considered for managing migraine headaches.

However, there is a reason why regulatory agencies in the UK have updated their guidelines. Evidence has been accumulating that this drug causes congenital malformations or neural tube defects in children of mothers exposed to the drug. Not only that, it also seems to increase the risk of these inborn errors even if fathers have been exposed to drugs within three months of conception.

However, not everyone agrees with such strict guidelines. This drug is quite suitable for controlling seizures, and some researchers think that UK regulatory agencies have gone too far without taking into consideration various other factors.

In the US, it appears that guidelines are not changing. This is because experts say that it has been long known that valproate causes congenital disabilities, and some of the highly reliable studies were published more than 15 years ago.

Moreover, The American Epilepsy Society (AES) already has very clear guidelines. It prohibits the administration of the drug on women planning to get pregnant.

So, why have UK regulatory agencies come up with these recommendations? Well, it appears that there is a reason for that. Although previous guidelines regarding avoiding its prescription in women planning to get pregnant have helped, those have not been as effective as expected. Experts say that despite the reduction in valproate use in women of childbearing age, it remains a significant issue. Still, two to three babies are born in the UK each month who were exposed to this toxic drug in utero.

All this means that women are still not being adequately informed about the risks posed by this drug. Here, it is vital to understand that valproate has been in use for managing bipolar disorder and epilepsy for several decades, and it is generally quite safe. It isn’t safe in just a specific population group.

Health experts in the US think introducing a strict ban like in the UK is not a good idea. Since this will pose certain challenges for doctors, they say that doctors often prescribe this drug when other measures have failed. So, a strict ban regarding valproate may have negative consequences, too.

US experts say that they are well aware of the risks, as the first evidence regarding neural tube defects in newborn babies to mothers exposed to valproate emerged in the 1980s. This means that adequate guidelines are already in place to avoid the use of this drug in women who plan to get pregnant. Moreover, since the discovery of these side effects, valproate use has significantly declined in women living with epilepsy.

Further, experts note that introducing a ban like the UK means that doctors will have trouble prescribing this drug to those women who do not plan to have children anymore. Moreover, many women living with epilepsy may not want to get pregnant at all due to various reasons.

US experts are also skeptical about introducing such measures for men. Although there is a growing body of evidence about increased neurodevelopmental disorders in the offspring of men who took valproate three months before conception, most data come from weak retrospective observational studies.

To conclude, experts in the US say that they do not need to introduce the ban like in the UK, though they agree that there is a need to introduce stronger warnings for valproate.

Summary: A federal study reveals critical gaps in post-overdose care for Medicare beneficiaries, highlighting the need for timely interventions like MOUD and naloxone to prevent future overdoses and deaths. Despite their proven effectiveness, these treatments are underutilized, leaving many at risk. Addressing these gaps is essential to saving lives amid the ongoing opioid crisis.

The opioid crisis continues to devastate communities across the United States, with overdose deaths reaching unprecedented levels. Despite ongoing efforts to curb this epidemic, a recent federal study highlights a critical area of concern: the care received by Medicare beneficiaries following a nonfatal overdose. 

The study, conducted by leading health agencies, underscores the importance of timely and effective interventions while also revealing significant gaps in care that leave many individuals vulnerable to subsequent overdoses and death.

The Stark Reality of Nonfatal Overdoses

The study published in JAMA Internal Medicine examined a cohort of 137,000 Medicare beneficiaries who experienced a nonfatal overdose in 2020, paints a sobering picture. Among these individuals, nearly 24,000 (17.4%) suffered another nonfatal overdose within the following year, and approximately 1,300 (1%) died from an overdose during that same period. 

These statistics underscore a harsh reality: experiencing one overdose significantly increases the risk of future overdoses and death.

It means that people who have experienced one overdose are more likely to experience another. This insight highlights the urgent need for effective, lifesaving interventions to be administered immediately following an overdose to prevent further harm.

Effective Interventions: A Lifesaving Necessity

The study’s findings make it clear that certain interventions can drastically reduce the risk of death following an initial overdose. Among the cohort, those who received medications for opioid addiction treatment or behavioral health support were significantly less likely to die from a subsequent overdose. 

Specifically, individuals treated with methadone had 58% lower odds of dying from an overdose, while those who received buprenorphine saw a 52% reduction in their risk. 

Behavioral health services and crisis interventions were associated with a 75% reduction in overdose mortality, further demonstrating the critical role these services play in saving lives.

In addition, the study found that filling a prescription for naloxone, a medication used to reverse opioid overdoses, reduced the risk of overdose death by 30%. Naloxone, commonly known as Narcan, is a vital tool in the fight against the opioid crisis, capable of reversing the effects of an overdose and providing individuals with a second chance at life.

Gaps in Care: A Call for Action

Despite the proven effectiveness of these interventions, the study reveals troubling gaps in care. Alarmingly, only 4.1% of the Medicare beneficiaries in the study received MOUD after their nonfatal overdose, and just 6.2% filled a prescription for naloxone. 

These figures highlight a critical disconnect between the availability of lifesaving treatments and their actual use in post-overdose care.

The study found that the median wait time for beneficiaries to receive MOUD was 72 days after their initial overdose—far too long in the context of an urgent health crisis.

The Opportunity for Intervention

The study’s results contribute to a growing body of evidence that highlights the need for more timely and widespread use of MOUD and overdose reversal medications in post-overdose care. At a time when over 100,000 people die each year from overdoses, the opportunity to intervene immediately following a nonfatal overdose is critical.

The findings of this federal study make it clear that while effective treatments and interventions exist, they are not being used to their full potential. Bridging the gaps in post-overdose care requires a concerted effort to ensure that all Medicare beneficiaries—and indeed, all individuals—who experience a nonfatal overdose have immediate access to the care they need.

This includes increasing the availability and timely administration of MOUD, expanding access to naloxone, and ensuring that behavioral health services are readily available to support individuals in their recovery journey. 

Innovative solutions like telehealth addiction treatment can also play a crucial role in reaching those who may not have easy access to traditional healthcare services. By prioritizing these interventions and addressing the gaps in care, we can save lives and offer hope to those affected by the opioid crisis.

Source:

Jones, C. M., Shoff, C., Blanco, C., Losby, J. L., Ling, S. M., & Compton, W. M. (2024). Overdose, Behavioral Health Services, and Medications for Opioid Use Disorder After a Nonfatal Overdose. JAMA Internal Medicine, 184(8), 954–962. https://doi.org/10.1001/jamainternmed.2024.1733 

Summary: A new study using brain scans, computer algorithms, or AI found that all anxiety or depression patients can be classified into six different “biotypes.” They found that each biotype responds to different treatment approaches.

Anxiety and depression are the most common mental health issues globally. In a new brain imaging study, researchers have identified six distinct “biotypes” of depression and anxiety. This means that each biotype has a different clinical presentation due to changes in different brain parts.

Many such studies have become possible these days due to improvements in imaging methods and computation technology. This has enabled us to visualize even minute differences in brain scans of various patients.

What is incredible about these findings is that they may immediately impact how these conditions are treated. Such findings help doctors use personalized approaches toward the patients.

Can these findings help avoid trial and error?

Once the person is diagnosed with depression, doctors have much choice of different treatment methods. This may include the use of various pharmacological drugs and psychotherapies. 

However, one of the issues remains that it is unclear what will work in a specific patient and what will not. So, doctors would often start therapy with selected drugs and then adjust therapy according to the patient’s response. This is essentially a “trial and error” method. 

Till now, the therapeutic approach is more like “one-size-fits-all.” Doctors use specific treatment guidelines that classify various drugs as first-line, second-line, adjuvant, and so on. So, once they have diagnosed the condition, they will start with first-line treatment. If that does not work, they might change the treatment. If things get worse, they might add other medications. 

However, this approach does not work in many patients. In fact, half of the patients do not respond well to drug therapy. 

Of course, doctors have long noticed that anxiety and depression patients differ a lot in their clinical presentation. However, they still had no objective methods of classifying these patients into different groups. Hence, they had to make therapeutic decisions based on their knowledge and gut feeling.

However, this new finding may completely transform anxiety and depression treatment. This shows that it is possible to classify these patients into six sub-types or “biotypes.” They differ not only in the clinical presentation of the disease but also in brain scans, confirming that different brain areas are affected by pathological processes in different biotypes.

For this study, researchers analyzed brain scans of 801 adults diagnosed with anxiety or depression. They also used advanced computing methods to visualize the difference between them. This advanced computing algorithm was able to classify them into six different “biotypes.” 

What has really excited researchers are the findings that each “biotype” responds to different treatment approaches. As already said, this can help eliminate a “trial and error” approach from the treatment. By identifying the patient’s specific biotypes, doctors can immediately start a specific kind of treatment.

Thus, for example, researchers noticed that if patients had overactivity in the cognitive region, then such patients responded really well to venlafaxine compared to other biotypes.

Whereas if patients had higher activity of three specific brain centers at rest when living with depression, those patients responded better to behavioral therapy.

Similarly, patients with lower activity of the brain center that controls attention span were less likely to benefit from behavioral therapy.

Of course, this is still a work in progress, as doctors are improving diagnosis algorithms using telehealth addiction treatments and better AI models. Nonetheless, this approach is good because it can be quickly introduced, as it requires less extensive clinical validation than creating new drugs. After all, it is more about helping doctors choose the right kind of treatment options that have already been approved. So, what this study is doing is taking out the guesswork from anxiety and depression treatment.

Source:

Tozzi, L., Zhang, X., Pines, A., Olmsted, A. M., Zhai, E. S., Anene, E. T., Chesnut, M., Holt-Gosselin, B., Chang, S., Stetz, P. C., Ramirez, C. A., Hack, L. M., Korgaonkar, M. S., Wintermark, M., Gotlib, I. H., Ma, J., & Williams, L. M. (2024). Personalized brain circuit scores identify clinically distinct biotypes in depression and anxiety. Nature Medicine, 30(7), 2076–2087. https://doi.org/10.1038/s41591-024-03057-9 

 

Summary: Many psychological interventions might not either work or even cause harm. Unlike medications, these therapies are not well regulated. Psychological interventions do not go through approval processes like drugs, and there is also a poorly adverse event reporting system. Experts believe that much psychological research on which these interventions are based is biased or flawed. Moreover, objective data is missing in most psychological studies, and results are based on subjective findings. The studies often have small sample sizes or give higher significance to less vital outcomes. Commonly used interventions like DARE have failed to reduce illegal drug abuse. Critical incident stress debriefing (CISD) does not appear to reduce the risk of PTSD. Most professional organs like APA recognize that the effectiveness of these interventions is controversial, and yet these psychological interventions remain popular.

Understanding some basic medical research concepts is essential to knowing how some psychological therapies are flawed or based on biased results.

Harm does not essentially mean some physical harm or unwanted effects. Even no benefit from therapy can be classified as harmful as it means loss of time and resources, investment in something that does not work.

The efficacy of psychological interventions is more complex to estimate. It is because most measures are “subjective” and not “objective.”

Subjective are like feelings and other symptoms reported by individuals that are difficult to measure. Thus, feel better, degree of fatigue, memory, focus, sadness, emotional stress are all difficult to measure. There is no way to measure these things accurately.

 

Objective data could be things like blood pressure, body weight, heart rate, blood glucose level. As one can see, these things are pretty measurable.

In psychology, most of the research is based on measuring or quantifying subjective data. Thus, bias can be readily introduced. 

Further, many such studies use a smaller sample size, that is, fewer participants. Generally, if any therapy has a small effect, it would need a greater number of participants to confirm or measure its effects.

Another way could be using the false endpoint or paying greater attention to insignificant findings. Just take an example of psychological intervention that involves telling students about the risks of drug abuse. And, at the end of the class asking them if students learned anything. Perhaps most would agree that intervention was beneficial. However, in reality, it may play no role in preventing drug abuse. 

Studies show therapies reporting fewer negative results

Researchers worry that many studies are biased these days. Just take an example of a study that analyzed 4600 papers on various medical subjects. The study found that in just seventeen years, between 1990 to 2007, reports of positive results have grown by 22%. It means that the objectivity of reporting is coming down¹.

Since in psychology, most data are subjective, things are even worse. One study found that almost close to 90% of research papers have wrong statistical analysis². Studies already show that there are many potentially harmful therapies (PHTs) due to incorrect reporting, greater significance to less critical facts, over-reporting of therapy effects. Sometimes unclear or difficult to understand statistical methods are used to confuse the readers³.

Unlike medications, US FDA does not regulate psychological therapies

There is a long and complex process to get medical drug approval, taking a decade in many cases. Further US FDA has an adverse effect reporting system. That is why some drugs that were initially shown good and cause harm later are withdrawn from the market⁴.

However, in the case of psychological interventions, things are very different. US FDA does not approve them. In some cases, they may get approval on the basis that are difficult to understand and even based on a single poorly designed study. Moreover, there is no sound system of reporting harms or lack of any effect from such a therapy.

Therapies that do not work

Many commonly used psychological interventions do not work and may even do more harm. Just take an example of the DARE program (Drug Abuse Resistance Education Program). There is little evidence that it works, and yet millions are allocated to this program each year. 

It is true that after the DARE program, many studies report that it helped, and an equal number of students also say that it did not impact them. However, if we look at the data on drug abuse among students since the start of the program, it becomes more than clear that it failed to achieve any of its objectives. On the contrary, statistics show that illegal drug abuse, alcohol abuse, have all risen⁵. Thus, many experts believe that funds allocated to this program could be put to better use, like improving the education system.

Another example could be critical incident stress debriefing (CISD), which involves a person exposed to stress or trauma to retell about this event to a group of individuals. Psychologists believe that it may result in ventilation and thus relief. It is a psychological therapy even commonly showed in various films to manage PTSD. However, there is no evidence that it works. American Psychological Association (APA) confirms that there are even paradoxical reports showing a higher risk of PTSD in those who were part of CISD⁶.

Many global organizations share this opinion. Thus, the British psychological society also thinks that most of these therapies do not work and may even cause harm, thus classifying them as PHTs⁷.

References

1. Fanelli D. Negative results are disappearing from most disciplines and countries. Scientometrics. 2011;90(3):891-904. doi:10.1007/s11192-011-0494-7

2. Nuijten MB, Hartgerink CHJ, van Assen MALM, Epskamp S, Wicherts JM. The prevalence of statistical reporting errors in psychology (1985–2013). Behav Res. 2016;48(4):1205-1226. doi:10.3758/s13428-015-0664-2

3. Williams AJ, Botanov Y, Kilshaw RE, Wong RE, Sakaluk JK. Potentially harmful therapies: A meta-scientific review of evidential value. Clinical Psychology: Science and Practice. 2021;28(1):5-18. doi:10.1111/cpsp.12331

4. Research C for DE and. Questions and Answers on FDA’s Adverse Event Reporting System (FAERS). FDA. Published May 22, 2019. Accessed October 8, 2021. https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers

5. Lesser B. Does the DARE Program Work? | Dual Diagnosis. Accessed October 8, 2021. https://dualdiagnosis.org/drug-addiction/dare-program-work/

6. critical-incident stress debriefing – APA Dictionary of Psychology. Accessed October 8, 2021. https://dictionary.apa.org/critical-incident-stress-debriefing

7. When therapy causes harm | The Psychologist. Accessed October 8, 2021. https://thepsychologist.bps.org.uk/volume-21/edition-1/when-therapy-causes-harm

Summary: Vaping is generally regarded as a safer option when compared to cigarette smoking. It is partially true as tobacco smoking has many ill effects on health, including a considerably increased risk of cardiovascular events and various cancers. In addition, cigarette smoking also causes ED. However, a new study indicates that vaping is also associated with considerable ED risk. The prevalence of ED is twice higher in those who vape regularly. ED is caused by nicotine, which reduces arteries dilation and suppresses testosterone levels. They noticed that casual vaping does not appear to increase ED risk. ED risk is only associated with regular vaping. Thus, researchers say that those who never smoked earlier should avoid vaping.

Adverse effects of tobacco/cigarette smoking have been known for decades. For example, tobacco smoking is associated with a higher risk of peripheral vascular disease, heart disease, lung cancer, and erectile dysfunction (ED).

However, more and more adults are switching to vaping in recent years, considering it a much safer option. Although it may be true, however, emerging studies now show that vaping also poses a considerable health risk.

Thus, the new study published recently found that healthy men who vaped daily had a twice greater prevalence of ED when compared to men who did not vape. The study included men aged 20 to 65 years of age. It also means that risk may be much higher in older adults¹.

As already stated, this was a study that only included healthy adults and individuals who were never cigarette smokers. Thus, it is clear that ED was explicitly caused due to vaping and was not associated with prior tobacco use or due to other health conditions. Online drug addiction treatment programs can provide essential support for individuals struggling with dependency, offering resources and therapies to address both substance use and related health concerns like vaping-induced issues.

Researchers intentionally excluded individuals diagnosed with diabetes, high cholesterol, obesity, cardiovascular diseases, as these conditions are independent risk factors for ED. In addition, they wanted to establish the role of vaping; thus, excluding confounding factors was essential.

Researchers say that they think there are two causes for ED associated with vaping. Firstly, nicotine and other chemicals in vapes have a direct adverse impact on arteries, which reduces their ability to dilate on sexual stimulation. Secondly, these chemicals also reduce testosterone levels in the body.

They say that these effects are pretty similar to cigarette smoking. However, cigarette smoking poses even more significant health risks due to the inhalation of thousands of toxic chemicals. Tobacco smoke contains more than 7000 known chemicals, and out of them, 250 are highly toxic, like ammonia, carbon monoxide, hydrogen cyanide. According to National Cancer Institute, these chemicals are highly carcinogenic².

 

The study also found that, like cigarette smoking, higher exposure to nicotine was associated with a greater prevalence of ED. Thus, ED was more likely to occur in those who vaped daily and not casually.

However, researchers say that there is a piece of good news, too. They found that this vaping-associated ED risk can be considerably reduced with the help of a physical activity.

Further, researchers warn that although vaping is promoted as a tobacco smoking cessation aid, things might differ. Researchers worry that the opposite may become true in many cases, and vaping may kick cigarette smoking habits. It is especially vital considering that more than 2 million middle- and high-school-going adolescents use e-cigarettes³.

Further, researchers noticed certain deficiencies in vaping products. They said that several zero-nicotine vaping fluids might contain nicotine in traces. Additionally, there is an issue with the amount of nicotine these devices deliver. Some vaping devices provide high amounts of nicotine, even higher than regular cigarettes.

There are certain limitations to the present study. For example, researchers are unsure if vaping causes temporary or permanent changes in the body. 

When researchers were asked what advice they would like to give regarding vaping. They said that advice is simple “if you have never smoked, then do not start.” Additionally, if you are vaping to stop cigarette smoking, then vape infrequently to get rid of cigarette cravings. However, the long-term goal should be to stop smoking completely.

References

1. El-Shahawy O, Shah T, Obisesan OH, et al. Association of E-Cigarettes With Erectile Dysfunction: The Population Assessment of Tobacco and Health Study. American Journal of Preventive Medicine. 2022;62(1):26-38. doi:10.1016/j.amepre.2021.08.004

2. Harms of Cigarette Smoking and Health Benefits of Quitting – National Cancer Institute. Published December 21, 2017. Accessed January 25, 2022. https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet

3. CNN MF. More than 2 million US teens use e-cigarettes, a quarter of them daily, CDC and FDA find. CNN. Accessed January 25, 2022. https://www.cnn.com/2021/09/30/health/youth-tobacco-survey-vaping/index.html

Summary: Despite years of research, drug addiction mechanisms are not fully understood yet. There are theories of positive reinforcement caused by euphoria or negative reinforcement caused by withdrawal syndrome and pain. Additionally, researchers know well about the involvement of the dopamine reward pathway. However, now new studies show that for drug addicts, even drug-seeking behavior itself is quite rewarding. With time it becomes deeply engraved in them, and they receive immense pleasure by seeking the drug, and sometimes this pleasure may play a greater role in drug addiction than substance abuse itself.

Despite decades of research, understanding the mechanism of drug addiction or substance use disorder (SUD) remains elusive. In addition, science is still struggling to understand why some can use substances in a controlled manner while others cannot.

Understanding the underlying mechanism of SUD is essential for finding an effective treatment strategy. However, it seems that SUD is quite a complex phenomenon with numerous overlapping mechanisms.

For example, addiction is well known to be a mix of psychological and physical dependence. Thus, some may seek drugs as they like the pleasure provided by them. On the other hand, others may go through physical pain on drug withdrawal.

Similarly, researchers have identified multiple neurobiological changes causing SUD. Thus, the dopamine-dependent reward pathway in drug abuse is well-known. Likewise, in recent years, the role of the endocannabinoid system has received increasing attention in drug-seeking behaviour¹. Online Drug Addiction Treatment offers effective ways to address these complex dependencies, providing individuals with accessible support and tailored treatment to aid in their recovery journey.

Perhaps the most established theories behind SUD are positive and negative enforcement theories. Positive enforcement means that a person gets euphoria on drug use and wants to repeat the experience².

On the other hand, negative reinforcement means that drug withdrawal causes pain, and thus person living with SUD seeks drugs to relieve pain².

So, what does this new study add to our knowledge of SUD?

This new study had quite a different approach. Researchers think that science has been focusing too much on the impact of drugs on the brain. However, researchers have overlooked that people with SUD spend considerable time searching for drugs, which leads to compulsive behavior and enforcement of drug-seeking behavior.

Simply said, people living with SUD are not just addicted to the substance. For them, seeking drugs itself is a kind of habit. If they are deprived of this habit, it causes distress in them. It means that drug-seeking behavior in itself becomes a satisfying activity.

 

Therefore, if a person is stopped from seeking drugs like by confining an individual, it results in a so-called “negative urgency.” There is a formation of so-called incentive habits. Finding a drug itself is a massive incentive for a drug seeker, not just using the drug.

SUD is now viewed as a psychiatric disorder, and this new study only enforces that concept. Moreover, it shows how drug-seeking habits become deeply ingrained in individuals living with SUD.

Researchers say that there has been a considerable focus on negative enforcement when the absence of drugs causes significant pain, anxiety, and mood disorders. However, this study adds an entirely new dimension to the understanding of SUD, as it shows that inability to find drug also results in negative emotional urgency. 

The inability to execute their habit itself causes significant distress for drug seekers. This study was done on animal models. And the research was published in Biological Psychiatry³.

To conclude, SUD is quite a complex disorder. Positive and negative enforcement play a significant role in drug addiction. However, those treating substance use disorder also need to remember that drug-seeking habit itself is quite a satisfying activity in many cases. Hence, therapeutic approaches to addiction treatment would need to consider these new findings.

Summary: Philip Morris acquired several healthcare companies in the last few years, including asthma inhaler producer Vectura for $1.52 billion. Though, its primary business comes from the sales of cigarettes and vaping pods. Cigarette smoking and vaping are well known to cause COPD, asthma, and severe lung disease. Thus, it appears that Philip Morris wants to gain influence in the healthcare sector by producing products to tackle respiratory diseases. These acquisitions would provide a company a greater say in healthcare, and at the same time, undermining the trust of people in healthcare companies. Thus, many think it is a similar business model followed by companies that created opioid epidemics in the US. As they first made the epidemic, and now capitalizing on its treatment.

It appears that Philip Morris is on a buying spree. It is not rare for large corporations to buy smaller ventures that fit into their business model. However, this time many eyes have been raised. It is because many recent Philip Morris acquisitions are of healthcare companies. So, recently it acquired Vectura for $1.52 billion¹.

Vectura specializes in making asthma inhalers. It means that Philip Morris may be trying to capitalize on the high prevalence of COPD and Asthma in various population groups. But that is not all. It may use the knowledge-base of healthcare companies to promote its other products, overcome certain legal issues, and even project itself as a company that cares about health.

Philip Morris is among the companies that contributed considerably to the rise of Asthma and COPD. And yet, it wasn’t easy for the healthcare organizations to make the company admit that tobacco poses health risks. It took billions of dollars of expenditure to prove that cigarette smoking was harmful to health. And, now, once this awareness has been raised, Philip Morris also wants to gain from these findings. 

 

For Philip Morris, the cigarette business remains the prime source of business. It has a turnover of about $76 billion. But now, it wants to achieve $1 billion from the pharmaceutical business. Experts believe that this would certainly undermine the trust of the population in medications. Moreover, the company has acquired many other healthcare firms, thus providing it a way of influencing the healthcare sector.

There is indeed some news coming that Philip Morris may exit the cigarette business in many nations². However, this does not mean that the company has changed. Its e-cigarette brand IQOS leads in vaping industry. The company promoted it as a safe alternative to tobacco smoking. However, these claims are now proven to be wrong. In fact, e-cigarette fosters the culture of smoking among the young. Even worse, it is related to a severe lung injury, irreversible injury with fatal outcomes in many cases³.

Despite the proven health risks of tobacco smoking and vaping, the company remains the leading player in this business. It does intend to leave this business until or unless these segments become financially unattractive. But then the company is always keeping an eye on other similar developing sectors. Thus, Philip Morris is open to enter the cannabis market.

Again, cannabis may become legal and more widely accepted, quite like cigarette smoking. Nevertheless, severe ill effects of cannabis abuse remain a medical fact – and online drug addiction treatment options are essential to address these issues. Philip Morris is ready to enter the segment if needed.

Thus, the company’s strategy of “Beyond Nicotine” does not point at the change in the company’s DNA. Its acquisition of pharmaceutical companies may rather point at more malicious plans. It is a step to gain lobbying power and influence in the health sector to ensure that its core business can continue unhindered.

Therefore, it would be right to draw parallels between the Philip Morris business strategy and that followed by opioid manufacturers. Many opioid manufacturers also produce medications to counter opioid dependency.

References

1. Subramanian S. Philip Morris wants to sell you inhalers for your asthma. Quartz. Accessed October 3, 2021. https://qz.com/2060628/philip-morris-wants-to-sell-you-inhalers-for-your-asthma/
2. Marlboro maker Philip Morris could stop selling cigarettes in UK. BBC News. https://www.bbc.com/news/business-57964253. Published July 26, 2021. Accessed October 3, 2021.
3. Health CO on S and. Smoking and Tobacco Use; Electronic Cigarettes. Centers for Disease Control and Prevention. Published August 3, 2021. Accessed October 3, 2021. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
4. Marlboro-Maker Philip Morris Keeps Cannabis Options Open. Bloomberg.com. https://www.bloomberg.com/news/articles/2021-04-28/marlboro-maker-philip-morris-keeps-cannabis-options-open. Published April 28, 2021. Accessed October 3, 2021.

The US is going through opioid epidemics, with a significant number of people abusing them. Thus, opiates have emerged considerable cause of mortality. In fact, now legal drugs kill more people in the US than illicit drugs.

Legal drugs are highly toxic at higher dosages. In addition, they generally have a so-called narrow therapeutic window. Moreover, those dependent on opioids are quite likely to use them at higher dosages due to the development of drug resistance. It means that they increasingly need a higher dosage to overcome pain, withdrawal symptoms, or experience a high.

Fortunately, these drugs are also well studied, and their pharmacology is well known to science. However, it is worth understanding that there are many opiates. Therefore, it is not a single drug rather a name for a group of chemically related drugs. 

Thus, there are substantial individual variances in the safety and pharmacokinetic profiles of various opiates. Some stay in the body for a short period, while others may remain for much longer. In addition, of course, some of the illicit drugs are also opiates. Thus, the most commonly abused opiates in the US are hydrocodone, oxycodone, and heroin.

Many factors affect drug metabolism in the body

Fortunately, most opiates are quite readily metabolized by the liver, and the body gets rid of them quickly, though their effect may last for much longer. 

 

It is vital to understand that when drugs undergo metabolism in the liver, they still produce some of the active metabolites, and thus much longer action of the drugs. Most opiates are generally taken as pills, though not necessarily. Thus, heroin can be snorted, injected, or smoked for faster and more predictable action.

There are many factors that affect how long any drug can stay in your body, and there are considerable individual differences:

• Individual metabolic rates differ, and factors like race and genetics play a considerable role in it.
• Body mass also plays a vital role, as it appears that generally, lean people can metabolize drugs faster. However, those with greater body mass may need drugs in more significant amounts to get high.
• Higher body fat content may also slow down the metabolism of drugs.
• Age is another factor, as there is a slow down in metabolism due to aging. That is why older adults are more likely to have high even at much lower dosages than young adults.
• Liver and kidney health plays a central role in drug detoxification. Those living with the diseases of these organs might struggle to metabolize drugs; thus, they may need more time to detoxify the body.
• How frequently opiates are used also influences their duration of action, as multiple dosages have an accumulative effect. Moreover, taking drugs too often may hamper some metabolic processes.
• The quality of drugs matters significantly, especially in the case of illicit drugs. 
• The amount of water in the body is another vital influencing factor.

How long do various opiates stay in the body?

Here we look at some of the most commonly used opiates. Among them, illicit drug heroin has an amazingly short-lived action, and the body can get rid of it quite quickly. Generally, in 5-7 hours, most of it has left the body. Thus, it is not detected in saliva tests after 5 hours and in the blood after about 6 hours. However, traces of it remain in the body for much longer, and tests can detect it for a week in urine. Similarly, it may accumulate in the hair and might be detected in them for about 90 days after the last use.

Hydrocodone is among the most commonly abused opiates used to treat painful conditions. Although it is a medication, but most people who abuse it may buy it from illegal sources. A saliva test can detect it for about 36 hours, a urine test for 2-4 days, and stays in hair for three months.

Morphine is another commonly abused painkiller that is detectable n the blood test for about 12 hours and in urine for 3 days or a bit longer. Again for the hair, the time period is 90 days.

Codeine is not just an excellent painkiller but also helps suppress dry cough. It is detectable in the blood for about 48 hours in urine for 24-48 hours. In saliva test for 1-4 days. However, in hair, tests can detect after 90 days.

Oxycodone of oxycontin is detectable in urine 1-4 days after last use. Generally, on average, drug tests may detect it for 3 days. It is present in a considerable amount in saliva for 48 hours. Like all other opiates, it remains in the hair for 90 days.

Finally, it is vital to understand that above are just averages. However, individual differences are immense. Moreover, those who are addicted to drugs are more likely to be tested positive, as their body is slow to metabolize the drugs. Drugs are tested in hair for much longer as they are metabolically not very active, and the body finds it difficult to get rid of them once the drug has accumulated in them.

Summary: A significant US population is living with opioid addiction. Studies show that most of them would like to be treated for the condition. However, poor access to medical treatment remains a significant barrier. Now, a new study shows that 61% of Americans are unaware that their primary care physician can prescribe addiction medication. Thus, the study highlights the importance of raising awareness among the population.

A new study shows that most Americans are aware of the fact that their primary care physician can prescribe addiction treatment. This means that they think that addiction can only be treated by specialists or in specialized clinics. This means that they do not seek help for their problem.

It is well-known that most of those living with substance use disorder (SUD) would like to get treatment for their condition. However, there are many well-known hurdles to seeking such treatment. One of the biggest hurdles to SUD is that treatment is not readily accessible in many places.

However, in recent years, the government has taken many steps. One such step includes allowing primary care physicians to prescribe addiction medications. 

There is a reason why previously primary care physicians were not allowed to prescribe these medications. Medications used to treat issues like opioid use disorder (OUD) are also opioids. However, these medications are much safer than the opioids that individuals living with OUD use.

Another way in which medications prescribed by doctors help is that they are much safer than illicit opioids. So, there are many reasons for considering OUD treatment. It may gradually help overcome opioid addiction and stay clean. 

However, people can only seek treatment if they are aware of the fact that even their primary care physician can prescribe opioid addiction treatment drugs. 

This new study published in one of the reputed journals, JAMA, had many surprising findings. It found that 61% of Americans are unaware that their primary care physician can prescribe medications for OUD. In fact, about 13% were completely sure that they could not.

This is despite the fact that the same study found that most of those living with OUD would like to be treated. Thus, 82% of those living with OUD were willing to seek treatment. Further, 53% agreed that primary care should provide OUD treatment, and 24% strongly agreed with it.

Additionally, the study also found that Black Americans were less aware of the fact that primary care physicians can help manage OUD, which explains the prevalence of health disparities when it comes to managing OUD.

 

 

 

This study is very important, considering that the US has less than 2500 addiction medicine specialists in the country, where millions are living with OUD. Hence, primary care physicians can play a significant role in managing the condition. However, for primary care physicians to help, patients must also need to be aware of where they can seek help.

This study shows that policy changes are often not sufficient. There must be a significant focus on increasing public awareness. There is a need for educational campaigns. Of course, primary care physicians must also participate in these campaigns, helping close these knowledge gaps.

Primary care physicians are the first and even the sole point of regular contact with healthcare services for many. Hence, primary care physicians can play an important role in raising awareness and providing lifesaving treatments to their patients.

Source: del Pozo, B., Park, J. N., Taylor, B. G., Wakeman, S. E., Ducharme, L., Pollack, H. A., & Rich, J. D. (2024). Knowledge, Attitudes, and Beliefs About Opioid Use Disorder Treatment in Primary Care. JAMA Network Open, 7(6), e2419094. https://doi.org/10.1001/jamanetworkopen.2024.19094

 

Summary: Less than 4% of those prescribed opioids may need treatment for opioid use disorder (OUD). However, a new study shows that barely 25% of them are getting buprenorphine or methadone for OUD treatment. Almost half are not getting any meds, and the rest are being treated with other medications. This may explain why a significant number of deaths are still occurring in those living with OUD. The study identified several reasons for this.

The opioid epidemic is a significant problem in the US, causing more than 80,000 deaths annually. Fortunately, death rates due to opioid use disorder (OUD) are declining. Unfortunately, they are not declining as fast as expected. One of the new studies suggests that the cause of significant OUD-related mortality could be that many are simply not getting meds to manage OUD.

Opioids are still among the most potent painkillers. There are many clinical or painful conditions that are best managed using opioids. Moreover, only a small number of those prescribed opioids develop OUD. Hence, OUD is not the reason to completely discontinue opioid use. There are millions of people benefiting from opioids, resulting in better pain control and quality of life.

 

 

When it comes to the small number of cases living with OUD, it is important to diagnose the condition early and provide proper care or medical treatment like telehealth addiction treatment. However, many of those living with OUD are simply not getting the right kind of treatment, resulting in poor treatment outcomes.

This new study has been published in one of the weekly reports by the CDC, which looked into the extensive data regarding OUD treatment.

In this new study, researchers analyzed the 2022 National Survey on Drug Use and Health (NSDUH) data for the year 2022. They found that about 3.7% of all those who use opioids need treatment for OUD. However, the study found that barely 25% of these individuals requiring OUD treatment are getting their meds.

That is not all; they also found health disparities. Thus, blacks were even less likely to be treated for OUD with meds compared to whites.

OUD is treated using medications like buprenorphine and methadone. Both of these drugs are milder and safer opioids. However, it is evident from the data that doctors are hesitant in prescribing these medications.

Thus, the study found that almost half of all the patients were being treated without medications. The rest of the patients were being given medications, but not buprenorphine or methadone, which are proven to work and save lives. All this results in inadequate treatment and, thus, harm.

It appears that most doctors are just too worried that their patients might start abusing treatment drugs, too. They seem to judge their patients too strictly. Researchers say that doctors need to develop a nonjudgmental approach to build trust with their patients.

The study also found that many doctors believed that using certain medications for treating OUD is equal to promoting illegal substance use. However, there are certain regulatory reasons, too. Methadone can be dispensed only from a Substance Abuse and Mental Health Services Administration–-certified opioid treatment program (OTP). However, many counties do not have any OTP, so doctors are not left with any choice.

Although buprenorphine is more accessible, a large number of pharmacies do not stock this drug for various reasons. Further, there are certain legal hurdles to prescribing buprenorphine, too. Many physicians simply cannot prescribe it, have too little experience, or have many concerns.

Simply said, OUD affects a small number of those who are prescribed opioids for chronic pain. It appears that a significant number of deaths occurring due to OUD can be prevented by sufficient treatment by providing OUD meds to more patients.

Source:

Dowell, D. (2024). Treatment for Opioid Use Disorder: Population Estimates — United States, 2022. MMWR. Morbidity and Mortality Weekly Report, 73. https://doi.org/10.15585/mmwr.mm7325a1