Recovery Michigan

New drug halves previously untreatable migraine attacks

A new drug offers fresh hope to the millions of people living with treatment-resistant migraine. The compound, called erenumab, has proven successful in people who had been failed by up to four previous preventative treatments.

The drug erenumab was tested in people with particularly challenging migraines that had been resilient to treatment. The compound reduced migraine attacks by 50 percent for a third of the study participants.

Dr. Reuter and team recruited 246 people with episodic migraines who had been failed by previous treatments.

More specifically, 39 percent of the participants had tried two previous medications to no avail, 38 percent had been unsuccessfully treated with three medications, and 23 percent had tried four drugs but had no success.

Three months into the treatment, 30 percent of the migraine patients in the intervention group had the monthly number of their attacks reduced by 50 percent, whereas only 14 percent of those in the placebo group had their attacks reduced by half.

This means that those who received the treatment were almost three times more likely to have their attacks halved. Importantly, the drug did not present any side effects.

Dr. Reuter comments on the study's findings, saying, "The people we included in our study were considered more difficult to treat, meaning that up to four other preventative treatments hadn't worked for them."

The Opioid Epidemic is Going to Get a Lot Worse Before it Gets Better

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According to the CDC, over half a million people died of drug overdoses between 2000 and 2015. In that time span, overdoses on prescription opioids more than quadrupled. Currently, around 91 Americans die every day of an opioid overdose — a fatality rate that has now surpassed the number of gun homicides in the U.S.

From 2002–2013, all indicators of heroin use rose among 18–25 year olds with approximately three out of four users reporting abusing prescription opioids prior to using heroin.

Considering that 1 in 5 people provided with a 10 day supply of opioids will become a long term user and many end up graduating to heroin, it’s not surprising that as sales of prescription opioids have nearly quadrupled from 1999 to 2014 overdose deaths and heroin abuse rates rose at a similar rate.

Interestingly, during this same time period there was no noticeable increase in the amount of pain that Americans reported overall. Yet that hasn’t stopped doctors from prescribing opioids to 1 out of every 5 patients with non-cancer pain or another pain related diagnosis — with the CDC noting that the rate of prescribing among specialists treating chronic and acute pain rose steadily from 2007 to 2012.

As heroin use continues to trend upwards, the majority of users are those who have graduated from prescription opioids that they either no longer have access to through a physician or can no longer afford. Heroin is much cheaper and more potent than prescription opioids, especially those purchased illicitly.

This means that out of the millions of Americans who would lose healthcare, as well as those who would see sharp increases in their premiums and copays, countless patients would be forced to go off their prescription opioids cold turkey as an economic necessity.

It’s statistically inevitable that many of these people would subsequently turn to heroin. At those rates it wouldn’t be out of the realm of possibility to see the total number of overdose deaths in the U.S. top 1 million before the end of President Trump’s first term, despite his campaign pledge to end the opioid epidemic.

Despite OD Risk, Opioid-Benzo Rx Continues

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Despite being well aware that patients who take benzodiazepines while on buprenorphine are at increased risk for overdose and death, more than half of doctors surveyed still prescribed the two together, according to a study presented here.

Among surveyed physicians who prescribed the opioid partial agonist buprenorphine in 2015, 54.8% said they had also prescribed a benzodiazepine to the same patient. In 2016, 61.3% said they had prescribed the two together, reported Karen Gerlach, PhD, MPH, of Pinney Associates in Pittsburgh.

Recent FDA guidance could make this practice more common.

"We've been watching this for quite a few years," Gerlach told MedPage Today. "We were already seeing a lot of co-prescribing and even from the same prescriber."

The researchers separately looked at buprenorphine-related deaths and found that benzodiazepine was also involved in 25.7% of the cases reported to the FDA's Adverse Event Reporting System, and in 49.3% of buprenorphine-related deaths in Florida, which has more detailed information than the FDA's database. In only one of 71 Florida autopsies was buprenorphine alone determined to be the cause of death.

"As you can see there are some serious outcomes," said Gerlach, during a poster session at the American Society of Addiction Medicine 49th Annual Conference.

The researchers looked at surveys from 2014 to 2016, taken in consecutive years by 1,214 doctors who prescribed buprenorphine. The surveys were conducted as part of the Buprenorphine-Containing Transmucosal Products for Opioid Dependence Treatment (BTOD) Risk Evaluation and Mitigation Strategy (REMS) program from the FDA -- approved in 2013 in order to reduce the risks of accidental overdose and death from buprenorphine-containing agents, and to raise awareness of the risks among patients, clinicians, and pharmacists.

They reported that the vast majority of doctors prescribing buprenorphine (97.3% to 98.3%) indicated they were aware of the increased overdose and mortality risk when patients also took a benzodiazepine, a central nervous system (CNS) depressant commonly used for treating anxiety.

People With Depression Use Language Differently -- Here's How to Spot It

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So far, personal essays and diary entries by depressed people have been useful, as has the work of well-known artists such as Cobain and Plath. For the spoken word, snippets of natural language of people with depression have also provided insight. Taken together, the findings from such research reveal clear and consistent differences in language between those with and without symptoms of depression.

Content

Language can be separated into two components: content and style. The content relates to what we express – that is, the meaning or subject matter of statements. It will surprise no one to learn that those with symptoms of depression use an excessive amount of words conveying negative emotions, specifically negative adjectives and adverbs – such as “lonely”, “sad” or “miserable”.

More interesting is the use of pronouns. Those with symptoms of depression use significantly more first person singular pronouns – such as “me”, “myself” and “I” – and significantly fewer second and third person pronouns – such as “they”, “them” or “she”. This pattern of pronoun use suggests people with depression are more focused on themselves, and less connected with others. Researchers have reported that pronouns are actually more reliable in identifying depression than negative emotion words.

We know that rumination (dwelling on personal problems) and social isolationare common features of depression. However, we don’t know whether these findings reflect differences in attention or thinking style. Does depression cause people to focus on themselves, or do people who focus on themselves get symptoms of depression?

Style

The style of language relates to how we express ourselves, rather than the content we express. Our lab recently conducted a big data text analysis of 64 different online mental health forums, examining over 6,400 members. “Absolutist words” – which convey absolute magnitudes or probabilities, such as “always”, “nothing” or “completely” – were found to be better markers for mental health forums than either pronouns or negative emotion words.

The Impact of Social Isolation on Pain Interference

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These data support the importance of Social Interaction (SI) as a factor in pain-related appraisal and coping and demonstrate that a comprehensive assessment of the individuals’ social context can provide a better understanding of the differential trajectories for a person living with pain.

Our study provides evidence that the impact of pain is reduced in individuals who perceive a greater sense of inclusion from and engagement with others.

This study enhances the understanding of how social factors affect pain and have implications for how the effectiveness of therapeutic interventions may be improved. Therapeutic interventions aimed at increasing social connection hold merit in reducing the impact of pain on engagement with activities.

Widely Prescribed Diabetes Drug Improves Nicotine Withdrawal Symptoms: Mouse Study

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Summary: Researchers report Metformin, one of the most widely prescribed drugs for diabetes, helped reduce symptoms associated with nicotine withdrawal in animal models.

Source: University of Pennsylvania.

Metformin, the most widely used medication for diabetes, has also been shown to help treat dementia and some cancers. New research from the Perelman School of Medicine at the University of Pennsylvania and Johns Hopkins Medicine shows smoking cessation may be added to that list.

In a new study in the Proceedings of the National Academy of Sciences the research team found that after giving mice metformin the animals displayed reduced symptoms when going through nicotine withdrawal.

“Although we are just beginning to characterize this new role for metformin, our study suggests that the protein it acts on could be a new target for smoking cessation treatment,” said senior author Julie Blendy, PhD, a professor of Systems Pharmacology and Translational Therapeutics at Penn.

Cigarette smoking is the leading cause of preventable disease and death in the United States, with more people dying from nicotine addiction than any other preventable cause of death. Even though quitting smoking brings many health benefits, the abstinence rate remains low with current medications, likely because of an array of undesirable withdrawal symptoms.

Metformin has a variety of targets, one of which is a protein called AMPK. This study showed that the AMPK pathway in the hippocampus of the brain is activated following long-term use of nicotine. But, this heightened AMPK activity is rapidly reversed during nicotine withdrawal, which is associated with negative symptoms such as anxiety.

Increasing AMPK levels using metformin decreases anxiety following nicotine withdrawal in the mice. Anxiety was measured in two behavior tasks that are designed to trigger relevant behaviors and contrast the tendency for mice to explore or engage in social investigation against the anxiety-producing properties of novel objects in the cage (the marble burying test) or an open, brightly lit space (a novelty-induced decrease in eating test).

Nonelderly Adults with Opioid Addiction Covered by Medicaid Were Twice as Likely as those with Private Insurance or the Uninsured to Have Received Treatment in 2016

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Among the 1.9 million nonelderly adults with opioid addiction, those with Medicaid were twice as likely as those with private insurance or no insurance to have received treatment in 2016, according to a new analysis by the Kaiser Family Foundation.

The role of Medicaid in combating the opioid epidemic has received renewed attention lately as the Trump Administration has declared addressing the epidemic a key priority and states have sought additional federal help. Forty-three percent of nonelderly adults with opioid addiction who were covered by Medicaid received inpatient and/or outpatient opioid addiction treatment services in 2016, compared with 21 percent of those with private insurance and 23 percent of those who were uninsured, based on analysis of data from the National Survey on Drug Use and Health.

Pain Management: Transcranial Magnetic Stimulation Study

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Stanford Systems and Neuroscience Pain Laboratory (SNAPL) has just launched a new study to test if Transcranial Magnetic Stimulation (TMS), a non-invasive brain stimulation technique, can reduce pain related to Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD).

TMS is FDA-approved to treat depression and is currently being researched for various other conditions. There is evidence to suggest that TMS can effectively treat certain types of pain and mood disorders. TMS uses a treatment coil placed over the head to administer brief magnetic pulses to a specific location to produce changes in the activity of neurons.

The duration of the study lasts up to 20 weeks and involves four in-person visits to the Stanford Pain Management Center in Redwood City, CA, in addition to weekly electronic questionnaires. Study procedures and TMS treatment are at no cost and participants will receive compensation for their time.

Click here to view a handout on frequently asked Qeustions about transcranial magnetic stimulation.

Many People Taking Antidepressants Discover They Cannot Quit

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Victoria Toline would hunch over the kitchen table, steady her hands and draw a bead of liquid from a vial with a small dropper. It was a delicate operation that had become a daily routine — extracting ever tinier doses of the antidepressant she had taken for three years, on and off, and was desperately trying to quit.

“Basically that’s all I have been doing — dealing with the dizziness, the confusion, the fatigue, all the symptoms of withdrawal,” said Ms. Toline, 27, of Tacoma, Wash. It took nine months to wean herself from the drug, Zoloft, by taking increasingly smaller doses.

“I couldn’t finish my college degree,” she said. “Only now am I feeling well enough to try to re-enter society and go back to work.”

Long-term use of antidepressants is surging in the United States, according to a new analysis of federal data by The New York Times. Some 15.5 million Americans have been taking the medications for at least five years. The rate has almost doubled since 2010, and more than tripled since 2000.

Nearly 25 million adults, like Ms. Toline, have been on antidepressants for at least two years, a 60 percent increase since 2010.

The drugs have helped millions of people ease depression and anxiety, and are widely regarded as milestones in psychiatric treatment. Many, perhaps most, people stop the medications without significant trouble. But the rise in longtime use is also the result of an unanticipated and growing problem: Many who try to quit say they cannot because of withdrawal symptoms they were never warned about.

Some scientists long ago anticipated that a few patients might experience withdrawal symptoms if they tried to stop — they called it “discontinuation syndrome.” Yet withdrawal has never been a focus of drug makers or government regulators, who felt antidepressants could not be addictive and did far more good than harm.

The drugs initially were approved for short-term use, following studies typically lasting about two months. Even today, there is little data about their effects on people taking them for years, although there are now millions of such users.

Expanding use of antidepressants is not just an issue in the United States. Across much of the developed world, long-term prescriptions are on the rise. Prescription rates have doubled over the past decade in Britain, where health officials in January began a nationwide review of prescription drug dependence and withdrawal.

In New Zealand, where prescriptions are also at historic highs, a survey of long-term users found that withdrawal was the most common complaint, cited by three-quarters of long-term users.

The Partnership for Inclusive Disaster Strategies: Make your own video- it’s easy!

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The Partnership for Inclusive Disaster Strategies wants YOU to talk about why disability-inclusive disaster preparedness and recovery is important!

People with disabilities are two to four times more likely to be injured or killed in a disaster. Why is this?

People with disabilities are often left out of emergency preparedness plans, which leads to a lack of consideration and preparation for their needs.
Example: During televised emergency announcements, sometimes ASL interpreters are not on the screen- or- are not qualified ASL interpreters.

We invite you to submit a short (1 to 2 minute) video explaining why emergency preparedness professionals need to #GetItRight and include people with disabilities in their emergency preparedness planning process- from start to finish.

The Partnership for Inclusive Disaster Strategies will compile these videos into a playlist, #DisabilityInclusiveDisasterPrep, caption them, and share them on social media.

We’ll start sharing these videos to ramp up the energy for the Partnership’s 2018 National Getting It Right Conference in Washington, DC on May 23 to May 25.

This is your chance to tell emergency preparedness professionals they need to to include the disability community in emergency planning and response process.

The Partnership has prepared a guide to walk you through the steps to create this video, including filming, talking points, and sending a link to us so we can caption it and include it in our playlist.