One of the latest clinical studies found that intraoperative use of methadone could significantly reduce the need for post-tonsillectomy opioid use in children. Moreover, the study found that methadone was more effective than fentanyl in reducing the requirement for opioids.

In the US, more than half a million tonsillectomies are performed each year. Many of these patients require prolonged use of opioids for pain control in the post-operative phase. Moreover, there are no strict guidelines or consensus regarding opioid use in these patients. Hence, researchers carried out a study to understand how to reduce the use of opioids in these patients.

They were especially interested in exploring the role of methadone as an opioid-sparing therapy. Methadone is an opioid with an excellent safety profile. This drug is also used to manage opioid use disorder. However, It can also help reduce pain. What is good about methadone is its long half-life of 1 to 2 days. It means that a single dose of this drug can provide prolonged pain relief. Researchers also wanted to see how methadone works compared to short-duration opioids like fentanyl, which has a half-life of a few hours only.

In this new clinical study, researchers wanted to check the hypothesis that using methadone will not just provide good pain relief but it will also reduce the need for opioid use. They also wanted to check if methadone was superior to short-action opioids like fentanyl.

This study was done in children 3 to 17 years old undergoing tonsillectomy. They were either given methadone intravenously (0.1 mg/kg or 0.15 mg/kg) or short-acting opioid fentanyl. They compared the effectiveness of perioperative use of these opioids with control subjects. They also assessed how well these approaches worked for pain control.

In the study, researchers found that intraoperative use of methadone could reduce the need for oral morphine in the post-operative phase significantly. Further, they also found that a methadone dosage of 0.15 mg/kg was most effective for pain control and reducing the need for oral opioids in the post-operative phase. Methadone was much more effective compared to fentanyl in reducing the need for opioids after tonsillectomy.

Methadone was as good as fentanyl for pain control, and it was well-tolerated. It could reduce the need for opioids. Thus, a single dose of methadone used intraoperatively was better than multiple dosages of fentanyl.

There could be many reasons why methadone was superior. But, perhaps one of the most significant reasons for these findings is that methadone has an exceptionally long half-life. It means that even a single dose of methadone can provide prolonged pain relief, something not characteristic of fentanyl.

Of course, this was still an exploratory study. Nonetheless, this study found that methadone was significantly better than fentanyl, and it could reduce opioid use in the post-operative phase in a pediatric population.

In recent years, there has been increased interest in methadone’s role in pain management. It appears to be good for controlling various pain and is also among the safer opioids.

Tonsillectomy is among the most painful surgeries in children, and these findings provide hope for better pain control.

At present, methadone isn’t routinely used for pain control in pediatrics. It is uncommon to use methadone to control other kinds of pain. There is a need for more extensive trials to understand the role of this opioid in pain management.

Source:

Einhorn, L. M., Hoang, J., La, J. O., & Kharasch, E. D. (2024). Single-dose Intraoperative Methadone for Pain Management in Pediatric Tonsillectomy: A Randomized Double-blind Clinical Trial. Anesthesiology, 141(3), 463–474. https://doi.org/10.1097/ALN.0000000000005031

One of the most extensive retrospective studies found that co-prescription of stimulants and opioids may be fueling a twin epidemic of overdose. Those prescribed stimulants require opioids at higher dosages for pain control and vice-versa.

Although opioid prescription rates have declined in recent years in the US, but opioid overdose-related deaths are still very common. There are several reasons for that, including a poor understanding of the opioid epidemic.

Opioids are still one of the most effective painkillers, especially for those living with chronic pain. For many patients, nothing seems to work except opioids.

When trying to understand opioid use disorder (OUD) and opioid overdose-related deaths, it is vital to understand that most patients are taking multiple medications. It also means that certain drugs might increase opioid overdose risk. Now, one of the new and most extensive studies to date shows that those who are prescribed stimulants to manage ADHD along with opioids are at a much greater opioid overdose risk.

This new study was published in The Lancet Regional Health – Americas. It looked into health claims of 3 million US patients who were prescribed stimulants and opioids. They believed that prescribing these drugs together may increase the risk of a twin epidemic.

Both of these drugs act very differently on the brain and have an opposing action. However, in some instances, doctors need to prescribe these drugs together. Stimulants are mainly used to manage ADHD, which is a diagnosis for a lifetime, often requiring prolonged or continuous treatment with these drugs. However, many of those living with ADHD may also develop chronic pain and require opioids to manage their pain. But, since these drugs have quite an opposing action, those taking stimulants may require higher dosages of opioids for pain control and vice-versa. That is why prescribing them together may increase the risk of a twin epidemic.

In the study, researchers analyzed 96 million opioid prescriptions and a total of 2.9 million patients. So, researchers analyzed a massive dataset, making their study quite robust.

Of course, things are not that simple, as there are many different kinds of opioids, like codeine, hydrocodone, methadone, oxycodone, morphine, and others. So, researchers had to calculate or standardize things using morphine milligram equivalents (MME) of opioid use by those patients. Hence, they had to use lots of computation.

In the study, researchers found that 160,243 or 5.5% of those on opioids were also prescribed stimulants. They found that those who were prescribed stimulants needed higher dosages of opioids. Further, using stimulants along with opioids means that doctors often need to increase opioid dosage. Additionally, individuals prescribed these drugs together were also more likely to be living with other mental health issues like anxiety and depression along with ADHD.

Nonetheless, even when correcting for these confounding factors, researchers found that prescribing stimulants to those taking opioids resulted in opioid dose escalation. This means that if doctors prescribe stimulants to those taking opioids, they are required to increase opioid dosage for adequate pain control.

So, this study suggests that the use of stimulants may increase the risk of opioid overdose and vice versa. This study could identify one of the reasons behind this twin epidemic.

Co-prescription of these drugs not only increasesthe risk of drug overdose but also increases the risk of mental health issues and cardiovascular events.

Source:

Lee, S., Song, W., Bates, D. W., Urman, R. D., & Zhang, P. (2025). The recent trend of twin epidemic in the United States: A 10-year longitudinal cohort study of co-prescriptions of opioids and stimulants. The Lancet Regional Health – Americas, 44. https://doi.org/10.1016/j.lana.2025.101030

A new systemic review suggests that ketorolac might be quite effective for post-surgical pain control, like those in spine surgery patients. It may significantly reduce the need for opioids in these patients. However, researchers also noticed that most studies using ketorolac have small sample sizes and thus need more extensive studies.

Non-steroidal anti-inflammatory drugs (NSAIDs) have been around for long. They are the most extensively used painkillers globally. They help reduce not only pain but also inflammation and fever. Aspirin and Ibuprofen are examples of some of the commonly used NSAIDs that are even available without prescription in many nations.

There are tens of NSAIDs, and they differ in potency, duration of action, and safety profile. What makes these drugs great is that most of them have an excellent safety profile. That is why many drugs from this class are even sold without a prescription.

These drugs are quite good for mild to moderate pain. Some are better at reducing inflammation, while others are better at suppressing pain. So, there is a significant difference between various NSAIDs. Some of the NSAIDs are even good for severe pain or chronic pain. Thus, there is a need to fully understand the difference between various NSAIDs. Moreover, these drugs can sometimes replace opioids, or they reduce their requirement significantly – something well-known to doctors.

However, despite their proven safety record, it is unfortunate that there is insufficient research into their use in different clinical conditions. Though there are many small clinical studies, robust data/findings from large clinical trials are often missing. This is the reason why doctors are hesitant to use them for certain pain conditions.

Ketorolac is one such NSAID. It is known to be quite good for pain relief, especially for acute pains like postoperative pain. It may significantly reduce the requirement for opioids.

A systemic review was recently published to explore its efficacy in managing pain after spine surgery. Studies suggest that whether used alone or in combination with other painkillers, ketorolac may benefit significantly those undergoing lumbar spine surgery. Moreover, ketorolac may be used along with opioids or other painkillers.

In the new study, researchers could identify 13 studies on the topic. In these studies, ketorolac was used either alone or along with medications like bupivacaine, morphine, epinephrine,acetaminophen, and pregabalin.

Researchers found that ketorolac was significantly better than placebo for pain control within six to 12 hours and 12 to 24 hours after spinal surgery. Further, they found it was particularly good for suppressing pain within the first six hours. However, its ability to reduce pain was less pronounced after six hours. So, after six hours, its effects started declining.

Additionally, ketorolac use could significantly reduce postoperative morphine requirements. Which means it could reduce the need for opioids.

Not only that but due to pain reduction and probably due to its anti-inflammatory properties, it could also reduce hospital stay duration a bit.

However, issues like nausea, vomiting, and constipation were as common in the ketorolac group as in the control group. Further, researchers cautioned that in some individuals, ketorolac may cause severe side effects like acute kidney injury, gastric bleeding, and anaphylaxis, something that must be kept in mind when using it for pain management.

Although study authors noted that ketorolac appears to be good for post-surgical pain control, they also noted that most studies on the topic had small sample sizes. Thus, there is a need for larger clinical trials to define its role in pain management in such patients.

Source:

Guan, J., Feng, N., Yang, K., Abudouaini, H., & Liu, P. (2024). The efficacy and safety of ketorolac for postoperative pain management in lumbar spine surgery: A meta-analysis of randomized controlled trials. Systematic Reviews, 13(1), 275. https://doi.org/10.1186/s13643-024-02685-z

Summary: Some states in the US allow NPs to prescribe buprenorphine for OUD. A new study comparing outcomes from states where NPs are allowed to prescribe opioids to states where they are not shows that this did not result in an increase in high-risk prescriptions or a significant change in health outcomes.

Few states in the US have allowed nurse practitioners (NPs) to prescribe opioids to curb opioid epidemics. However, one of the latest studies shows that this did not result in better outcomes.

Not all, but few US states have allowed NPs to prescribe buprenorphine for managing opioid use disorder (OUD). The reason behind such a decision was to improve access to treatment. However, this did not result in better outcomes.

The findings of this new study were published in the JAMA Health Forum. This study compared the outcomes in states where NPs can prescribe opioids with states where they are not allowed to do so. In the study, experts did not find any statistically significant benefit.

While giving such rights to NPs may sound like a good idea, but not everyone agrees with this. Many believe that NPs are not just trained enough to handle complex OUD cases. Moreover, managing OUD is not just merely about prescribing buprenorphine. Managing OUD is quite challenging, requiring a deeper understanding of the topic.

On the other hand, supporters of these changes say that treatment access remains one of the most significant hurdles.

In this new study, researchers compared opioid prescription and outcomes by comparing the data from six states where NPs can prescribe opioids with 10 neighboring states where NPs are not allowed to prescribe opioids. This was a study done between January 2012 to December 2021. Researchers used insurance claims data from Blue Cross and Blue Shield Plans for the study. They analyzed the data of adults aged 18 to 64 years of age.

They found that in states that allowed NPs to prescribe, those did not have similar kind of demographic characteristics and opioid prescription patterns.

However, when researchers say that they did not see any change in opioid prescription to high-risk individuals, it also means that they did not find any issues with NPs prescribing these drugs. This did not increase any risk, and this did not result in overprescription or prescribing to wrongly selected patients.

Despite declining opioid prescriptions for chronic pain management, OUD remains one of the most significant problems. Prescription opioids might have played some role in this epidemic, but there are many other drivers of this epidemic. This explains why the problem continues to be relevant. Hence, many health experts have even challenged the need for reducing opioid prescriptions for chronic pain, as it might be causing more harm than good.

Thus, to manage OUD, it is essential to improve treatment access. There are a few ways of improving this access to OUD treatment, like allowing NPs to prescribe certain opioids or allowing the prescription of specific opioids through telemedicine platforms.

These new approaches to enhancing treatment access might not be making significant improvements, but studies also show that these regulatory changes are also not causing harm. Improve access to drugs like buprenorphine did not result in an increase in high-risk prescriptions.

Thus, it would be correct to say that although these new approaches might not significantly improve OUD treatment, they are not causing harm.

Source:

Cusimano, L. D., & Maestas, N. (2024). High-Risk Opioid Prescribing and Nurse Practitioner Independence. JAMA Health Forum, 5(12), e244544. https://doi.org/10.1001/jamahealthforum.2024.4544

Summary: As opioid use for chronic pain becomes less common in the US, doctors are exploring alternatives. One of the latest studies shows that many physicians are switching to medical cannabis instead. Thus, the use of medical cannabis is increasing, and the use of opioids is decreasing.

There is no doubt that opioids are among the most potent painkillers known to science. That is why they are preferred for severe pain and also to manage chronic pain. Moreover, opioids are not just painkillers, as they help in multiple ways. This explains why they are so effective for chronic pain.

However, now, one of the new studies shows that many doctors might prefer medical cannabis over opioids. Due to ever-changing guidelines, doctors are now more hesitant to prescribe opioids.

In recent years, opioid prescriptions have declined in the US. Opioid prescription guidelines have become more stringent due to safety concerns.

Surely, companies that produce opioids are also working to improve the safety of opioids. There is little chance that doctors will stop using opioids anytime soon. Opioid manufacturers are trying to develop drugs that have better safety profiles and opioids less likely to cause addiction and other health issues.

However, till then, it appears that doctors are actively looking for safer and yet effective options. Hence, many are increasingly prescribing medical cannabis. Although medical cannabis is not as potent for pain relief as opioids, but it might be quite good for certain chronic pain conditions due to its numerous effects, like the ability to reduce stress and modulate other brain pathways.

So, for this study, researchers analyzed data on direct payments from opioid manufacturers to physicians. In the study, they found that such payments are decreasing. Manufacturers of opioids make these payments to doctors to improve the professional skills of physicians and to ensure better prescribing practices. However, now, due to declining prescriptions, such payments have become less common.

Researchers say that this is also because doctors are increasingly viewing medical cannabis as a substitute for opioids for chronic pain treatment. Moreover, doctors are pretty excited about medical cannabis, and they think that, in some instances, it may be even superior to opioids.

Of course, when it comes to medical cannabis, things are still evolving. For several decades, cannabis remained classified as a controlled substance, which prevented research into its health benefits. However, now cannabis and its products are being increasingly used.

Sure, there are many different kinds of cannabis products, from very mild CBD-based products available without prescription to medical cannabis prescribed by doctors.

CBD is now a very popular topic, as health experts realize that cannabis extract has many cannabinoids with different modes of action. Moreover, these cannabinoids may even have opposing actions.

Thus, there are cannabinoids like cannabidiol or CBD with relaxing effects, and then there is THC known to cause intoxication. Although THC may cause intoxication, but it is also more potent for certain medical conditions, and for severe pain, and other health issues. Thus, medical cannabis contains full-spectrum cannabis extract that is high in CBD, THC, and other minor cannabinoids.

Medical cannabis cannot be compared to CBD products solely online since it has a much higher concentration of cannabinoids like CBD, THC, and other cannabinoids. This makes medical cannabis much more potent, but it also means that there are also safety concerns regarding its prolonged use.

To sum up, medical cannabis is slowly emerging as one of the potent treatments for chronic pain. Doctors are now increasingly viewing it as a substitute for opioids.

Source:

Karmakar, B., Mukherjee, G., & Kar, W. (n.d.). Using Penalized Synthetic Controls on Truncated Data: A Case Study on Effect of Marijuana Legalization on Direct Payments to Physicians by Opioid Manufacturers. Journal of the American Statistical Association, 0(0), 1–16. https://doi.org/10.1080/01621459.2024.2406583

Summary: One of the latest studies shows that consuming alcohol, even in small amounts, makes people more tolerant of pain, making them less empathetic to others and more aggressive. Thus, aggression associated with alcohol intake is due to reduced pain sensitivity.

Alcohol is a mind-altering substance and is widely consumed in various parts of the world. If consumed responsibly, it is quite safe. However, alcohol addiction is not rare. Thus, for example, studies report that about 29 million adults are living with alcohol use disorder (AUD) in the US.

High alcohol intake is associated with many harms. It damages the liver, kidneys, brain cells, and more. It also causes a deficiency of certain nutrients. It significantly increases malnutrition risk.

A significant area of concern is that alcohol alters the short-term and long-term behavior of those who consume it frequently. Thus, for example, those who are intoxicated are more likely to behave aggressively. Most of those living with AUD show aggressive behavior. Now, one of the latest studies shows that this issue is due to a reduced pain threshold.

It has been long known that alcohol may reduce pain sensation, but what is new in this study are findings that alcohol may have a long-term impact on pain threshold. This reduced pain sensation makes those living with AUD less empathetic, and they are more likely to be insensitive to others and behave aggressively.

Alcohol inhibits brain neurons. So, at higher dosages, it alters sensations, including pain sensations. In the olden days, alcohol was used as an anesthetic. However, it is no longer used as an anesthetic due to a very narrow safety window.

It is vital to realize that most alcohol benefits are at very small dosages. However, at higher dosages, it is mostly harmful. Alcohol overdose is also life-threatening. Alcohol causes both acute and chronic adverse effects. Thus, for example, acute intoxication may alter a person’s ability to make decisions and have a negative impact on motor function. However, in the long run, chronic alcohol consumption may even alter the working of the brain.

 

Thus, for example, the present study was done on individuals who were not essentially living with AUD. These were people who consumed alcohol casually, drinking 3-4 alcoholic beverages a month. Even these individuals showed changes in the working of their brains.

These were the results of two independent studies with 543 and 327 participants. In both studies, participants were divided into two groups, with one group given an alcoholic drink and another placebo that resembled alcoholic drinks due to their low alcohol content. Then, both groups were exposed to painful stimuli. Researchers found that alcohol-drinking groups were more resilient to pain or less sensitive. Moreover, alcohol also made individuals more aggressive, and they were more ready to tolerate pain.

So, researchers say that this also makes such individuals who drink alcohol insensitive to the pains of others. On the other hand, those who do not consume alcohol can feel greater pain, and they would not like to inflict pain on others.

Here, it is essential to note that those who participated in the study had blood alcohol levels between 0.095% and 0.11%. This is marginally above the legal limit in most states, which is 0.08%. So, this shows that even small amounts of alcohol can suppress pain sensations and make individuals more aggressive.

Thus, it is also logical to conclude that this effect would be even more pronounced in those who drink alcohol heavily and frequently. Therefore, those living with AUD become more aggressive towards others in the long run. For those struggling with alcohol addiction and its consequences, online alcohol addiction treatment offers a promising solution for recovery and long-term health.

Source:
DeWall, C. N., Giancola, P. R., & Bushman, B. J. (2024). Too Insensitive to Care: Alcohol Increases Human Aggression by Increasing Pain Threshold. Journal of Studies on Alcohol and Drugs, jsad.24-00144. https://doi.org/10.15288/jsad.24-00144

Summary: Many patients experiencing severe pain are not administered opioids even when other medications fail to help. One of the new studies shows that when opioids are administered in an emergency care setting to opioid naïve patients, it does not pose an addiction risk.

Not every kind of opioid use poses an addiction risk. This is especially important to understand, as an increasing number of voices are being raised to reduce opioid use in clinical practice. However, reducing opioid use or discontinuing opioids in all clinical scenarios may do more harm than good.

Opioids are among the most potent pain relievers. They are exceptionally good for managing moderate to severe pain. Opioids are equally suitable for managing acute and chronic pain.

Unlike in chronic health issues, when opioids are used for managing acute pain, they are less likely to cause addiction or even other harm. This is because, when they are used to manage acute pain, their use is not prolonged.

For example, opioids may provide excellent relief to a person with a broken leg or arm or in other kinds of traumas. These drugs are really good for use in emergency medicine. Moreover, in emergency medicine, these drugs are injected under medical supervision, and thus, they rarely cause any severe side effects.

However, in the last few years, opioid use in various clinical scenarios has declined. This is because many believe that even short-term use of opioids may cause addiction and other harms. However, one of the new studies shows that these concerns are ill-founded. The use of opioids in emergency rooms is unlikely to cause addiction.

 

This new study was published in The Journal of Emergency Medicine. In the study, researchers screened 1555 patients. In the final study, 506 patients were included. These were patients who were administered opioids in the emergency room. Some of the commonly used opioids were hydromorphone and morphine.

In the study, researchers followed these patients for 6 months after their last visit to the emergency department or opioid use. They found that at 6 months, just one of those patients was persistently using opioids. Hence, it would be right to say that the risk of addiction to opioids when they are used in an emergency room is close to 0% or nil.

Here, it is also worth noticing that these were opioid naïve patients. It means that they had no prior experience of opioid use. They received their first opioid injection in an emergency care setting. This study confirms that when opioids are administered in such settings, they do not pose any risk of addiction.

Moreover, researchers further noticed that after treatment in the emergency room, 63 of the patients were even given opioid prescriptions on discharge. However, all of them discontinued opioid use after their recovery,  and only one of the patients continued opioid use at 6 months. This highlights that Opioid Addiction treatment is rarely needed when opioids are used responsibly in emergency settings, as the risk of addiction is minimal.

Researchers say that one should still use opioids with extreme care and only when there are strong clinical indications, like severe pain uncontrolled by other painkillers like acetaminophen. However, they also say that their study shows that when opioids are used carefully, they are safe, helpful, and do not cause addiction.

There is some sound data that many patients are being refused parental opioids, even when they are experiencing severe pain, a pain that other drugs could not control, which means that excessive precaution or worries regarding the side effects of opioids are causing more harm than good.

Of course, this is not the first study in this direction. Previous studies have also shown that the chances of opioid addiction are really low when they are used in emergency settings and in patients.

Source:

Irizarry, E., Cho, R., Williams, A., Davitt, M., Baer, J., Campbell, C., Cortijo-Brown, A., & Friedman, B. W. (2024). Frequency of Persistent Opioid Use 6 Months After Exposure to IV Opioids in the Emergency Department: A Prospective Cohort Study. The Journal of Emergency Medicine, 67(2), e119–e127. https://doi.org/10.1016/j.jemermed.2024.03.018

Summary: New reports show that opioids are in short supply, and things are unlikely to improve. DEA has been cutting down production quotas, and manufacturers have also been hesitant to produce these drugs due to rising litigation costs.

The US has been going through an era of drug shortages for quite some time. This problem has been especially acute during the last few years. However, as the COVID-19 problems eased, so did the drug supply. But, this did not change things for patients living with chronic pain, as the shortage of opioids persists. Thus, drugs like oxycodone, hydrocodone, and many other painkillers or opioids are in tight supply.

Surely, the latest report by the American Society of Health-System Pharmacists (ASHP) shows that things are improving, and thus, drug shortages have declined from a peak of 323 to 277. However, as one can see, there is still not much improvement.

These shortages are affecting many essential medications, and not just opioids or painkillers. Thus, there is a significant shortage of various IV fluids, dialysis fluids, or sterile fluids. Such acute is this shortage that the American College of Emergency Physicians is asking specialists to use tap water for cleaning wounds instead of sterile irrigation fluid.

There are some other worrisome facts. Despite the information, it appears that not enough is being done. Thus, for example, industry stakeholders have not been able to explain the reason for the deficit of many drugs. However, they do say that it is due to multiple reasons like increased demand, manufacturing problems, raw material shortages, and business decisions.

When it comes to opioids, surely, regulatory changes are among the significant reasons. DEA production quota is insufficient to meet the requirements of opioids, leading to rationing of these drugs. Therefore, surveys show that 90% of patients have difficulty getting their opioid prescriptions filled by the pharmacy.

In fact, some of the drugs, like Transmucosal Immediate-Release Fentanyl Medicines (TIRF), have been discontinued by the manufacturer. This drug is used in a small number of patients to manage severe pain in cancer patients, and those patients have now been left without any options.

Although manufacturers are not saying why they have discontinued producing certain opioids, industry experts think that it is not difficult to understand. Many of the manufacturers have been experiencing losses and legal issues, so they decided to discontinue producing certain opioids.

As per ASHP, oxycodone, hydrocodone, hydromorphone, fentanyl patches and solutions, and morphine solutions are some of the opioids that are in short supply. These are some of the most potent painkillers and widely used opioids, and their short supply means that a significant number of patients have to seek other options.

 

Some industry experts warn that things are unlikely to get better since, in 2025, the DEA would further reduce the quota for producing opioids. If the quota is implemented, it will only make things worse.

These shortages are not only making it difficult to manage severe and chronic pain but also causing other health issues. Thus, many patients are experiencing higher levels of anxiety, and they have to struggle a lot to get their prescriptions filled.

Doctors are already raising the alarm, and some of them have written to the regulatory agencies that any cut down in the production of opioids will cause significant harm to their patients. In fact, these shortages are also causing stress and burnout in physicians, as they feel helpless and unable to help their patients. Doctors say it is regretful to see that patients must call 10-20 pharmacies and often travel hundreds of miles to get their medications.

Further, if those living with chronic pain do not get these medications, they are more likely to consider other ways to manage their pain, which may include using illicit drugs, which may further make things worse. This creates an added concern for doctors specialising in opioid addiction treatment, as it may lead to a rise in illicit drug use and related complications.

 

Summarize: One of the new studies analyzed gene expression in brain cells of those living with Alzheimer’s and alcohol use disorder (AUD), and they found many similarities. Thus, this study suggests that AUD may increase Alzheimer’s risk and also fasten its progression.

It would be right to say that alcohol is the most widely consumed legal, mind-altering substance in the US. Sure, caffeine is also classified as a mind-altering substance, but it does not cause euphoria or intoxication like alcohol does. Alcohol consumption also causes behavior changes.

When consumed responsibly, alcohol is safe, but at higher dosages, it is harmful. There have been many studies regarding the use of alcohol. Studies show that about 10% of US adults consume alcohol in dosages greater than recommended, or about 29 million adults in the US are living with alcohol use disorder (AUD). Those are massive numbers.

Similarly, Alzheimer’s is also one of the most common diseases. It is among the top 5 leading causes of mortality in the US. At any given time, more than 7 million adults are living with Alzheimer’s in the US.

So, it would be right to explore the association between AUD and Alzheimer’s. Moreover, it is no secret that people drink alcohol because it modulates brain activity. This also means that not all alcohol use-related modulations in brain physiology are good. At higher dosages, alcohol may damage brain cells and alter brain chemistry. Chronic alcohol use, like that by people living with AUD, may result in some irreversible brain changes.

Now, one of the new studies shows that AUD may accelerate Alzheimer’s progression in some individuals living with specific kinds of genes. The study found that many of those living with AUD or Alzheimer’s have similar types of gene expression patterns in the brain.

The findings of this study were published in the journal eNeuro. Researchers say that they found that those living with Alzheimer’s have similar kinds of genes and pathways dysregulated as those living with AUD. This suggests a link between the ailments, and it also suggests that chronic alcohol use or abuse may fasten Alzheimer’s progress. For individuals looking to address alcohol use issues, exploring alcohol addiction treatment online may provide accessible and effective options.

What makes this research different is that it did not focus on DNA but rather on RNA and, thus, on the gene expression within the brain cells. So, they wanted to understand if there are similarities between the gene expression in those living with AUD and Alzheimer’s.

This study built on one of the previous studies showing that there are certain similarities in gene expression of those living with AUD and Alzheimer’s. So, for this study, researchers analyzed RNA sequences of hundreds of thousands of brain cells from 75 patients living with different Alzheimer’s stages and also compared the results with brain cells of 10 individuals without Alzheimer’s.

They found that gene expression was far more similar between those living with AUD and Alzheimer’s compared to healthy adults (not living with Alzheimer’s or abusing alcohol).

Researchers say that this deepens our understanding of Alzheimer’s. This study shows that alcohol must be included in the Alzheimer’s risk factors.

Of course, there is still a need for more extensive studies in this direction. Nonetheless, this study brings some new insights. Moreover, it shows how analyzing a single cell may help better understand certain complex diseases like Alzheimer’s. For those struggling with AUD, options such as alcohol addiction treatment online can make help more accessible, potentially mitigating these risks early.

Source:

Joshi, A., Giorgi, F. M., & Sanna, P. P. (2024). Transcriptional Patterns in Stages of Alzheimer’s Disease Are Cell-Type–Specific and Partially Converge with the Effects of Alcohol Use Disorder in Humans. eNeuro, 11(10). https://doi.org/10.1523/ENEURO.0118-24.2024

Summary: One of the most extensive studies to date shows that methadone has much lower dropout rates when used to treat opioid use disorder than buprenorphine, making it a better choice. Moreover, both methadone and buprenorphine are equally safe in real-world conditions.

When treating opioid use disorder (OUD), dropout rates remain a significant issue. A new study done in British Columbia shows that dropout rates with methadone are 37-40 lower than those with buprenorphine.

The new study was published in the JAMA Network, and it was one of the most extensive studies to date that analyzed more than 30,000 patients treated for opioid use disorder between January 1, 2010, and March 17, 2020.

Despite the best efforts, OUD remains a significant issue in the US. Although in recent years, opioid prescriptions have declined, OUD cases have not declined as expected. This is due to the widespread use of opioids for chronic pain. Further, many people continue to use illicit opioids for their pain.

However, as the awareness about the health risks of OUD increases, much has changed. In the US, now it is easier to get certain prescription drugs for OUD, and some of them even through telemedicine, thus helping enhance treatment accessibility and helping overcome the social stigma associated with the condition.

At present, there are three options for managing OUD that is methadone, buprenorphine, and naltrexone. Among them, methadone and buprenorphine are the most commonly prescribed drugs for OUD. Despite their widespread use, some knowledge gaps remain, like which one is better for initiating therapy and which of these two most popular drugs is associated with lower treatment discontinuation rates.

Methadone works amazingly well since it is also an opioid but a much safer opioid. Thus, it is excellent for overcoming withdrawal symptoms. However, methadone can only be dispensed by federally registered Opioid Treatment Programs (OTPs), which is its significant downside.

 

On the other hand, buprenorphine is less stringently controlled. Commonly called “bupe,” it also helps reduce carving and is a partial opioid. Since December 2022, certain regulations have changed, making it easier for qualified clinicians to prescribe this drug. This means that, over the years, buprenorphine has become more popular for opioid addiction treatment.

There are reasons for more strict regulations regarding methadone, as there are greater chances of people living with OUD abusing this drug.

However, there are also worries that these stringent regulations might be having a negative impact on OUD treatment. But, to date, evidence has been mostly missing.

However, this new study shows that methadone may be better due to much lower discontinuation rates. Considering the study duration and massive sample size, the study results are generalizable to various parts of the North American continent.

The study also analyzed the incidence of adverse events in both groups, and it found that both drugs were equally well tolerated. Though methadone was slightly more likely to cause side effects compared to buprenorphine, there wasn’t any statistically significant difference between the groups.

One of the reasons for the more widespread use of buprenorphine in the US and less stringent regulations is the belief that it has a better safety profile. However, when it comes to analyzing the safety profile of any drug, it is also vital to consider its overall efficacy.

At least, this study shows that methadone, in real-life conditions, is not likely to cause significantly more side effects than buprenorphine, though it is much more effective. Hence, these findings must be taken into consideration by policymakers to ensure better methadone availability for opioid addiction treatment.

Source:

Nosyk, B., Min, J. E., Homayra, F., Kurz, M., Guerra-Alejos, B. C., Yan, R., Piske, M., Seaman, S. R., Bach, P., Greenland, S., Karim, M. E., Siebert, U., Bruneau, J., Gustafson, P., Kampman, K., Korthuis, P. T., Loughin, T., McCandless, L. C., Platt, R. W., … Socías, M. E. (2024). Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder. JAMA. https://doi.org/10.1001/jama.2024.16954