Poppy seeds are known to cause false positives on drug tests; in one case, a new mother's baby was taken away after she failed a drug test due to eating a poppy seed salad.

Poppy seeds come from the Papaver somniferum plant, which is also used to make drugs like opium and morphine. In fact, many drug tests are so sensitive to opiates that the U.S. Department of Defense cautions service members to avoid foods with poppy seeds to prevent a drug test mix-up.

But is it actually possible to get high off of poppy seeds alone?

While your average poppy seeds likely have no intoxicating effects, it is technically possible to get high from poppy seeds — but it's definitely not safe.

Related: How does a poppy seed bagel trigger a positive drug test?

Poppy seeds themselves contain little to no opiates. However, other parts of the poppy plant, such as the seed pods, contain opium, which can be further refined into substances such as morphine, codeine and heroin.

"People have safely consumed poppy seeds for hundreds of years because the seeds themselves don't naturally contain opiates, but when they mix with other parts of the plant during harvest, opiate residue can end up on the seeds," Eva Greenthal, a senior policy scientist at the Center for Science in the Public Interest in Washington, D.C., told Live Science in an email.

Most commercially available poppy seeds — like those you'd find in the spice aisle in a grocery store — are processed in a way that removes that opiate residue. However, unwashed or poorly processed poppy seeds could potentially contain enough opiates to intoxicate a person.

Still, it would be difficult (not to mention unpleasant) to eat enough straight poppy seeds to get high. On his website Science Questions with Surprising Answers, Christopher S. Baird, a physics professor at West Texas A&M University, estimates that you would have to eat up to 130 pounds (59 kilograms) of poppy seeds to have a noticeable effect. These numbers were based on a 2003 quantification of morphine and codeine concentration in commercially available poppy seeds.

However, brewing poppy seeds in hot water can produce a more concentrated effect. Poppy seed tea is sometimes even touted online as a natural, homemade pain remedy — but according to Greenthal, it's anything but.

"This practice is extremely dangerous and can lead to overdose and death," she cautioned.

Poppy seed tea is especially risky because the quantities of opiates in a bag of unwashed poppy seeds can vary wildly from batch to batch, making safe and consistent dosing nearly impossible.

In a study published in 2021, Greenthal and colleagues found that there had been at least 19 deaths and at least 20 nonfatal overdoses attributable to poppy seed tea.

Even if poppy seed tea doesn't cause death or overdose, it can sometimes lead to dependence. In a 2019 report, Irving Haber, a pain management specialist at Terre Haute Regional Hospital in Indiana, described the case of a 42-year-old man who learned that poppy seeds were available for purchase online and began to make tea from them. Over time, he began needing more and more poppy seed tea every day, and he reached a point where he was no longer able to manage his business or personal affairs due to his addiction.

The patient ended up needing buprenorphine and naloxone, a medication combination used to treat opioid withdrawal. Other case reports include that of an 82-year-old woman who consumed up to half a gallon (2 liters) of poppy seed tea daily for years and that of a 26-year-old man who required methadone therapy to kick his $1,000-a-week poppy-seed-tea habit.

Since helping the patient in his clinic, Haber — alongside Steve Hacala, the parent of Stephen Hacala, a college student who died in 2016 after overdosing on poppy seed tea — has been petitioning the U.S. government to ban the sale of opiate-contaminated poppy seeds.

"We're just trying to close a door, so to speak, on another abusable source of morphine," Haber said.

This article is for informational purposes only and is not meant to offer medical advice.

Electrical brain stimulation could temporarily make patients with chronic pain more susceptible to hypnosis, new research suggests. The researchers behind the study argue this could potentially offer patients a safer alternative to long-term opioid treatment for fibromyalgia, a chronic-pain condition. 

Opioids are not recommended to treat fibromyalgia under current guidelines. However, despite this, they are still sometimes prescribed to patients with the condition.

In a small clinical trial, scientists briefly applied electrical stimulation through the skulls of volunteers with fibromyalgia. The stimulation increased the volunteers' susceptibility to hypnosis for an hour — a trait that was once thought to be unchangeable.

The authors of the new study, published Thursday (Jan. 4) in the journal Nature Mental Health, believe that such stimulation could someday be used to increase patients' responsiveness to hypnotherapy, which has previously been investigated as a potential approach to treating fibromyalgia, although the data is limited.

As the U.S. contends with an ongoing opioid overdose epidemic, hypnotherapy may also provide a safer alternative to long-term use of these addictive drugs, the authors argue.

Related: Electrical stimulation could treat traumatic brain injuries

"Opioids are very dangerous — yes, they help control pain acutely, but they kill people chronically," Dr. David Spiegel, the co-senior study author and a professor of psychiatry and behavioral sciences at Stanford University, told Live Science.

Hypnosis is when a trained practitioner guides a person into an altered state of consciousness, which typically relaxes them and focuses their attention. The procedure has been tested to treat conditions such as stress and sleep disorders, and it's also been tested as a pain-reliever during surgery and as a method to help people quit smoking.

Around 15% of adults are considered "highly hypnotizable," meaning they'd score either 9 or 10 on a standard 10-point clinical scale of hypnotizability, while two-thirds of adults are "somewhat hypnotizable."

Scientists previously thought that hypnotizability was fixed, meaning your level of hypnotizability can't change. However, Spiegel and colleagues wanted to see whether they could change this by tweaking the electrical activity in people's brains.

Their trial included 80 patients with fibromyalgia who Spiegel said were "low-to-mid-range" in hypnotizability. The researchers used paddles held to the outside of the skull to stimulate a region of the brain called the dorsolateral prefrontal cortex, the brain's executive control region.

Their aim was to increase communication between the dorsolateral prefrontal cortex and part of what is known as the brain's "salience network," Spiegel said. This network acts like an alarm system that tells the brain to pay attention to new stimuli in our environment.

"Coordination between these two regions, the executive control region and the salience region, helps you to concentrate more intently and is something we see with more highly hypnotizable people," Spiegel said.

Related: This light therapy could zap away chronic pain one day

Half of the participants received two 46-second pulses of electricity to this region, while the others acted as a control group and didn't actually receive stimulation to the brain. Clinicians assessed each individual's hypnotizability before and after treatment. Patients had to follow a series of instructions during the hypnosis attempt, and their responses were rated out of 10.

Those who received stimulation showed a significant increase in their hypnotizability score compared with the control group, going up by about one point on the scale, on average. These effects lasted for only an hour, but Spiegel thinks that, with further refinement, the treatment could be useful for pain relief.

Hypnosis is not a treatment in itself, but more like a stepping stone: "Obviously the goal is not to get a bunch of people hypnotized, but to get them to use it to solve a problem and with fibromyalgia, it's pain," Spiegel said. Hypnosis can be used to help shift people's sensations, perceptions, thoughts or behaviors. When paired with talk therapy, it could potentially increase people's cognitive flexibility and receptiveness to new ideas, Spiegel said.

The authors plan to test longer lengths of stimulation to see if they observe greater improvements in hypnotizability, in terms of duration or greater increases on the 10-point scale.

Eventually, they'd like to see it developed into a clinical procedure that combines brain stimulation with hypnosis to reduce or eliminate pain.

This article is for informational purposes only and is not meant to offer medical advice.

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A distinct pattern of birth defects has been identified in children of mothers who used fentanyl illicitly during pregnancy.

This pattern, so far reported in 10 children, appears to be a new syndrome that's never been described before, doctors reported in September in the journal Genetics in Medicine Open.

All 10 children had been exposed to multiple drugs during pregnancy, but the only substance they all had in common was fentanyl, although details of the exact timing and degree of exposure are unknown. Notably, the possibility that a contaminant in the fentanyl, rather than the opioid itself, caused the syndrome cannot yet be ruled out.

The 10 cases in the report were on the East Coast and in California, and the study authors have since become aware of four more in the Midwest, senior study author Dr. Karen Gripp, the chief of the Division of Medical Genetics at Nemours Children's Health in Wilmington, Delaware, told Live Science in an email.

"While it is still possible that the same contaminant is in street fentanyl throughout the country, the wider distribution of cases, all connected with prenatal fentanyl use disorder, may support this connection [to fentanyl alone]," she said.

Related: Father's use of diabetes drug could raise his kids' risk of birth defects

When examined, the 10 infants were of short stature, had small heads and had distinctive facial features, including small lower jaws and short-length noses. Several children also had cleft palates, as well as malformed feet or genitals. Several of the infants also had short, broad thumbs or fused toes.

Some of the symptoms resembled those of Smith-Lemli-Opitz syndrome (SLOS), a developmental disorder caused by mutations in a key gene involved in making cholesterol. Genetic testing and biochemical tests ruled out this diagnosis. An analysis of the children's facial features also ruled out fetal alcohol syndrome, which is tied to specific characteristics. This analysis was corroborated by the fact that only one of the children had reportedly been exposed to alcohol in pregnancy.

The long-term prognosis for children with the syndrome is not yet known, Gripp said. One child described in the report did die at 3 months old, but the other nine survive and are being treated.

"The children we know have shown some developmental delay and feeding issues with need for a feeding tube," she said. "None are older than toddlers, so we really do not know their long term outcome."

Six of the children were identified during treatment at Nemours Children's Health, and the remaining four were added to the study after being flagged at other institutions. Anecdotally, the team has since heard of additional children with similar symptoms whose mothers also used fentanyl during pregnancy. The severity of symptoms varies, hinting that the syndrome ranges from mild to severe.

Scientists knew fentanyl crossed the placenta and could cause birth defects — however, how it causes the specific symptoms seen in the new syndrome is not yet clear. Based on fentanyl's chemical structure, the study authors hypothesized that the opioid may derail cholesterol production by binding to key compounds involved in the process. This would help explain why the syndrome resembles SLOS.

Gripp said her team is collaborating with another lab to probe this potential cholesterol-related mechanism. They also plan to identify more patients with the syndrome. Unfortunately, "because these mothers do not receive good prenatal care, it will be difficult to document how many of their children show findings of this new syndrome," she said. Learning how prevalent the syndrome is will require an effort by large agencies, like the Centers for Disease Control and Prevention.

It's important to note that the syndrome has only been seen in children of mothers with opioid use disorder, who regularly used large amounts of fentanyl during pregnancy, Gripp said.

"That is very different from using a prescribed amount once or twice during pregnancy or delivery," she said. "In addition, the timing matters. Only drugs used early in pregnancy can result in birth defects like cleft palate. This is not caused by medication used during delivery," for example, when patients are sometimes given prescribed fentanyl for pain relief during labor.

You may have heard that, from the dental chair to the labor-and-delivery room, things hurt worse for redheads.

But do redheads really experience pain differently than other people?

Anecdotal reports from anesthesiologists and various animal and human studies suggest that having red hair is associated with an altered sensitivity to both pain itself and to pain-relieving medications, according to a 2023 review in the journal Anesthesiology and Perioperative Science. 

However, the details of how redheads' pain experience differs remain somewhat fuzzy, partially because past studies have all investigated different forms of pain, review co-author Jaideep Pandit, a consultant anesthesiologist at the Oxford University Hospitals' NHS Foundation Trust, told Live Science.

Related: How did doctors perform surgery before modern anesthesia?

Studies suggest that redheads are more sensitive to certain types of pain, but not others, Pandit said. One study found redheaded women were more sensitive to temperature-related pain and that the nerve blocker lidocaine was less effective in managing their pain than that of dark-haired women. Another study found that redheads were less sensitive to pain from electric shocks than other people.

Similarly, the link between ginger locks and pain management isn't straightforward. There's data suggesting that redheads need 20% more general anesthesia to stay sedated, and that they also require more local anesthesia to fend off pain. But data shows they're actually more sensitive to opioids, including mu-opioids, such as morphine and fentanyl, and kappa-opioids, although the latter effect may be specific to female patients.

Complicating matters, a 2015 study found no difference between redheads' and other people's responses to anesthesia or pain meds, so the data is somewhat mixed. 

While redheads may perceive some pain as more intense, they also have a higher pain threshold, according to Dr. David Fisher, chief of the dermatology department at Massachusetts General Hospital, who published a 2021 study on pain in red-haired mice. Red-haired mice and people appear to be somewhat numb to pain, at first. They don't perceive the pain until it reaches a higher threshold, but then, redheads feel it more intensely than others, Fisher said.

The pain experience of people with fiery locks has been challenging to explain, in part because humans are so genetically complex that it's tough to pinpoint a single genetic cause for their experience, Fisher told Live Science. 

So Fisher and his lab studied pain in mice, in which they had complete genetic control. With some exceptions, red hair is produced by mutations in the melanocortin-1 receptor (MC1R) gene; this gene helps control the type and amount of pigment in the hair, skin and eyes. Fisher's team studied mice that were genetically identical except for carrying a variant either for red hair or for black hair. 

To avoid bias, the researchers crossed these mice with an albino strain, so that they carried the red- or black-hair genes but didn't actually produce any pigment. "We saw exactly a difference in pain threshold between red and black hair, even when they weren't making pigment at all," Fisher said.

Why that's the case is complicated. The MC1R gene affects a protein in melanocytes, the body's pigment-making cells. Fisher's team found that, in addition to changing that protein, the redhead MC1R variant also causes mouse melanocytes — and, theoretically, human ones — to produce less of a substance called POMC.

POMC gets cut into several hormones that affect sensitivity to pain and opioids by helping control the activity of specific receptors. When mice have less POMC, it raises their pain thresholds, heightens their pain sensitivity, and reduces their responsiveness to some non-opioid pain drugs while boosting opioids' effects, Pandit said.

Red hair is believed to have offered an advantage in northern latitudes because it boosts ultraviolet absorption — a critical step in vitamin D synthesis —  but it's unclear whether redheads' altered pain and opioid sensitivity also offered advantages, Fisher said.

Although it's unknown why it evolved, the link between red hair and pain is confirmed, "which itself is fascinating," Pandit said. It's possible that doctors could eventually predict how a patient will respond to pain and pain medicines by looking at their genes.

This article is for informational purposes only and is not meant to offer medical advice. 

For the first time, the U.S. Food and Drug Administration (FDA) has approved a naloxone product — a medication that rapidly reverses the effects of opioid overdose — that can be purchased over-the-counter. 

The medication, Narcan, is a nasal spray that was approved as a prescription drug back in 2015, according to the FDA. To change the drug's status, the manufacturer provided data demonstrating that Narcan is safe and effective when used as directed and can be safely used by consumers without supervision. Based on this data, an advisory committee unanimously recommended that the drug be cleared for over-the-counter use, and the FDA has now acted on this recommendation.

All 50 states have "Narcan access laws" on the books that already allow pharmacists to hold a standing prescription for the drug and thus dispense Narcan or a generic equivalent to anyone who requests it — but many pharmacies chose not to do so, according to The New York Times. Many community-based organizations and local health departments do offer the drug at little to no cost, according to the Centers for Disease Control and Prevention (CDC). 

Related: Opioids are the most common cause of fatal poisonings in kids under 5

The approval of over-the-counter Narcan is expected to greatly improve access to the life-saving drug, which can revive a person experiencing an opioid overdose within two to three minutes.

"Today's approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country," Dr. Robert M. Califf, the FDA Commissioner, said in the agency's statement. "We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price."

The CDC offers simple instructional videos on how to use naloxone nasal spray, as well as how to use injectable naloxone, another version of the medication. 

Opioids account for more than 50% of the fatal poisonings reported among U.S. children ages 5 and younger in recent years, according to a new study. This makes opioids the most common contributor to fatal poisonings in that age group, followed by over-the-counter pain, cold and allergy medications.

The study, published March 8 in the journal Pediatrics, included data collected between 2005 and 2018 by 40 U.S. states that contribute to the National Fatality Review-Case Reporting System, a database that includes information on child and infant mortality. 

In the 13-year study period, 731 poisoning-related fatalities were reported in children ages 5 and younger. More than 40% of those affected were less than 1 year old, followed by 1 year olds, at 23%. Most cases noted where the poisoning took place, and of these, more than 65% happened in children's homes.

Overall, 346 of the fatal overdoses, or 47%, involved opioids. By comparison, over-the-counter pain, cold and allergy medications accounted for 108, or about 15%, of the fatal poisonings.

Related: Poison control calls about kids ingesting cough suppressant more than doubled in recent years

"Strikingly, opioids accounted for a progressively greater proportion of the substances contributing to poisoning-related deaths over the study period," the study authors wrote. In 2005, opioids accounted for seven out of 29 fatal poisonings, or 24%, and in 2018, the drugs accounted for 24 out of 46 fatal poisonings, or 52%. 

In the early 2010s, efforts to curb the overprescription of opioids likely helped reduce the number of child poisonings linked to the drugs, as there was a dip at that time, the authors wrote. However, "in the past decade, children have been exposed to new opioid sources, such as heroin, fentanyl, and opioids used in medication-assisted treatment (eg, methadone, buprenorphine), which have reversed previous public health gains," they wrote.

"Our study highlights how the opioid epidemic has not spared our nation's infants or young children," study author Dr. Christopher Gaw, a pediatric emergency medicine fellow at Children's Hospital of Philadelphia, said in a video accompanying the report. 

To help prevent overdoses, doctors should counsel children's caregivers on strategies to prevent poisonings and advocate for community-level interventions that address social risk factors, like poverty, that are linked to an increased risk of poisoning, Gaw said. Doctors should also educate families on when and how to use naloxone (brand name Narcan), a medication that can rapidly reverse opioid overdoses and is safe and effective in children, he said. 

In most states, naloxone is available without a prescription at pharmacies, although it may be sold behind the counter rather than over the counter, according to the Centers for Disease Control and Prevention. In addition, many community-based organizations and local health departments offer the drug at little to no cost. The Food and Drug Administration is also considering making naloxone nasal spray available over the counter in the future, STAT reported.

A horse tranquilizer drug often found mixed with opioids is increasingly involved in overdose deaths in some U.S. states.

The drug, called xylazine, is a sedative used in veterinary medicine, and it is not approved for use in humans. Recently, the tranquilizer began popping up in the U.S. illegal drug supply, frequently in combination with heroin or fentanyl (both types of opioids), a mixture sometimes referred to as "tranq dope," Live Science previously reported.

Now, Connecticut is the latest state to report a rise in overdose deaths involving xylazine, according to a report published Thursday (Sept. 16) in the Centers for Disease Control and Prevention (CDC) journal Morbidity and Mortality Weekly Report. In the new study, researchers from the Connecticut Department of Public Health found that unintentional overdose deaths in the state that involved xylazine increased from 5.8% in 2019 to 11.4% in the first half of 2020. Virtually all of the xylazine-associated deaths (99%) also involved fentanyl, the report said.

The findings are similar to those found in Philadelphia and published in a study earlier this year in the journal Injury Prevention. That study found that, between 2010 and 2015, xylazine was detected in just 2% of unintentional overdose deaths involving heroin or fentanyl. But by 2019, that figure had jumped to 31%, Live Science previously reported.

Related: 10 interesting facts about heroin

It's unclear exactly why xylazine is being added to the U.S. drug supply and whether the people who overdose are aware they are taking the drug. In Philadelphia, some focus groups have found that people who use illegal drugs report that xylazine makes the effects of opioids last longer, Live Science previously reported.

In another study, also published Thursday (Sept. 16) in MMWR, CDC researchers examined how widespread these xylazine-associated deaths are in the U.S. as a whole. The researchers found that, out of 38 states, xylazine-associated deaths were identified in 25 states in 2019.

Still, the total number of overdose deaths involving xylazine in the U.S. appears to be small — out of the more than 45,000 overdose deaths reported in 2019, only about 2% were positive for xylazine, the CDC researchers found. But when xylazine was detected, it was listed as a contributor to death in about two-thirds of cases.

What's more, the number of xylazine-related overdose deaths may be underestimated — the CDC authors note that routine postmortem drug tests may not look for the drug.

In humans, xylazine is known to cause potentially dangerous side effects, including low blood pressure and a slowed heart rate. While studies on the health effects of xylazine combined with opioids are limited, some research suggests that the mixture may increase the risk of opioid overdose death. Indeed, xylazine may increase the toxic effects of opioids by "potentiating sedation and causing respiratory depression" along with low blood pressure and a slow heart rate, the Connecticut researchers said.

The CDC researchers note that because xylazine is not an opioid, it won't respond to naloxone, the medication that can reverse opioid overdoses; and so naloxone may be less effective in reversing overdoses in cases where xylazine is also used.

The detection of xylazine-associated overdose deaths in half of U.S. states is concerning and warrants "continued surveillance" of the drug, the CDC authors said. Labs should implement routine postmortem testing for xylazine, which could help researchers better understand the role of the drug in overdose deaths, they said.

Originally published on Live Science.  

A horse tranquilizer is increasingly popping up as a street drug in the U.S., and it is now involved in nearly one-third of fatal opioid drug overdoses in Philadelphia, according to a new study.

The tranquilizer drug, called xylazine, is not considered an opioid, but it is often found mixed with the opioids heroin or fentanyl, a combination sometimes referred to as "tranq dope," according to the study published Tuesday (Feb. 2) in the journal Injury Prevention.

The researchers found that detection of the drug during post-mortem exams has spiked sharply over the past decade among people who have died from opioid overdoses in Philadelphia.

The findings suggest that "the opioid epidemic throughout the USA continues to evolve," the authors wrote. They say that overdose deaths involving xylazine may be underreported in the country because labs don't always test for it. The authors call for increased monitoring of xylazine abuse in the U.S., as well as its health consequences.

Related: 10 interesting facts about heroin

Animal tranquilizer 

Xylazine is a sedative used in veterinary medicine, particularly in horses. In the U.S., it is not approved for use in humans and is known to cause potentially dangerous side effects in people, including low blood pressure and a slowed heart rate.

Illicit drug users in Puerto Rico have been taking xylazine with opioids since the early 2000s, and more recently, it has appeared in the illegal drug supply in the continental U.S. Health departments in Maryland, Ohio and Michigan have all reported several cases of overdose deaths involving xylazine over the past two years. But overall, research on xylazine in the U.S. illegal drug supply is very limited.

In the new study, the researchers analyzed data on overdose deaths in Philadelphia from 2010 to 2019. Specifically, they examined unintentional deaths involving heroin or fentanyl, which are both types of opioids.

They found that, between 2010 and 2015, xylazine was detected in just 2% of these overdose deaths. But by 2019, that figure had jumped to 31%.

What's more, data on illegal drug seizures from the U.S. Drug Enforcement Administration suggest that xylazine is increasingly appearing in "polydrug" samples, which contain heroin or fentanyl along with other drugs. Between 2010 and 2013, none of the polydrug samples that were tested in the agency's labs contained xylazine, but by 2019, 25% contained the drug.

Studies on the health effects of xylazine combined with opioids are limited, but some research suggests that the mixture may increase the risk of opioid overdose death.

Still, the researchers note that their study could not determine which drug or combination of drugs was involved in the Philadelphia overdose deaths.

It's also unclear exactly why xylazine is being added to the U.S. drug supply and whether the people who overdosed knowingly took the drug. Some focus groups in Philadelphia have found that people who use illegal drugs report that xylazine makes the effects of opioids last longer, the authors said.

The authors concluded that "further study is needed to understand the synergistic effects of

fentanyl and xylazine use by humans and to better contextualize the reasons for its use in the USA." And whenever possible, health jurisdictions should consistently test for the drug, they said.

Originally published on Live Science.  

Though the COVID-19 pandemic has captured the country's attention, the U.S. has also been facing another deadly, but less visible, public health crisis. "Diseases of despair" or those related to substance abuse, alcohol dependency and suicidal thoughts and behaviors, have been surging in the U.S. over the past decade, according to a new study. 

Diagnosis of diseases of despair increased by 68% between 2009 and 2018 among a cohort of people studied in the U.S., according to a study published today (Nov. 9) in the journal BMJ Open. Strikingly, diagnoses related to suicide increased by 170% in that time frame, the authors found.

Previous research hinted that despair-related diseases were increasing across the U.S. but mainly focused on mortality.

Life expectancy  in the U.S. has declined steadily from 2015 to 2017, the longest sustained decline since about a century ago, and all-cause deaths among middle-age white people increased between 1999 and 2015, according to the study. Many of the premature deaths were "deaths of despair" such as suicides, overdoses and alcohol-related liver diseases.

Related: The drug talk: 7 new tips for today's parents

These trends coincide with decades of economic decline for less educated and unskilled workers, stagnant or falling wages and incomes, lower marriage rates and increases in single-parent households, and fewer people who are actively working or looking for work, according to the study.

"It is theorised that these changes have fostered growing feelings of despair, that is, disillusionment, precariousness and resignation," the authors wrote in the study. "Despair may in turn trigger emotional, cognitive, behavioural and even biological changes, increasing the likelihood of diseases that can progress and ultimately culminate in these deaths of despair."

In the current study, researchers analyzed the incidence of such diseases in 12 million people enrolled in health insurance plans between 2007 and 2018 through a large U.S.-based company called Highmark. The enrollees were concentrated in Pennsylvania, West Virginia and Delaware, three states that have been disproportionately affected by deaths of despair, according to a statement. They found that 515,830 of these people, or 1 in 20, were diagnosed with at least one disease of despair during that time period.

About 54% of those people were diagnosed with an alcohol-related disorder; over 44% with a substance-related disorder; over 16% with suicidal thoughts/behaviors; and a little under 13% with more than one disorder. Between 2009 and 2018, the rates of diagnoses of "diseases of despair" increased by 68%; the rate of alcohol-related diagnoses increased by 37%; substance related-diagnoses increased by 94%; and suicide-related diagnoses increased by 170%, according to the statement. 

People who were between 55 and 74 years old saw the largest increase in alcohol and substance abuse diagnoses, according to the study. Substance-related diagnoses in infants, from maternal drug abuse, increased by 114% across the study period. Suicide-related diagnoses increased by 287% among 1 to 17 year olds, by 210% among 18 to 34 year olds and 70% in everyone else.

Since the cohort enrolled with this insurance was concentrated in states with high prevalence of despair, the rates may not be as high everywhere in the U.S. Still, "increases in these conditions were found nationwide," said lead author Emily Brignone, a senior research data scientist at Highmark Health.

The study had several limitations. The data was drawn from people that filed insurance claims, "and the true rates of these conditions are likely even higher among those who are uninsured," Brignone told Live Science. What's more, previous research suggests that trends in deaths of despair vary by race and ethnicity but such data wasn't available in this study, she said. Also, the researchers weren't able to directly link diseases of despair to deaths of despair for individuals. "Rather, we compare trends in morbidity and mortality in more general terms," she said.

It will also be important to understand the impact of COVID-19 on diseases of despair, Brignone said.

"COVID-19 highlights many of our existing vulnerabilities," Brignone said. The disease has exacerbated unemployment, isolation, uncertainty and barriers to care, which are all associated with an increased risk of diseases of despair, she said.

"Fortunately, we do have effective treatments for depression and addiction," she said. "We have to improve outreach to people in need and remove barriers to care," such as with the institution of telehealth. Policies and programs to prevent the loss of healthcare coverage and replace lost income will likely also help decrease the impact of COVID-19 on diseases of despair, she said.

Originally published on Live Science.

Opioids jump-start the brain's reward system, provoking a burst of pleasurable feelings along with a dizzying drug-induced high. At least that's what scientists used to think.

But mounting research suggests that the average person doesn't actually reach this euphoric state on opioids, particularly not the first time they try it. In fact, people who are not addicted to opioids may feel subjectively worse after taking the drug, according to cognitive neuroscientist Siri Leknes. 

"I think that the notion that opioids [always] cause pleasure is a myth," said Leknes, who is a principal investigator at the University of Oslo in Norway. An individual's reaction to opioids depends on many interwoven factors, such as where the person is, their mood, previous drug exposure, genetics and metabolism, she explained. If scientists assume that opioids spark euphoria in most people, they run the risk of overlooking important differences in how individuals react to the drugs, whether on the operating table or in the addiction clinic. 

Leknes presented her preliminary findings on Oct. 20 at the annual meeting of the Society for Neuroscience in Chicago. Specifically, her new work investigates the effects of the drug remifentanil, an opioid commonly given before minor surgical operations to relieve pain, ease anxiety and boost the effects of anesthetics, according to the Mayo Clinic.

Related: 9 Weird Ways You Can Test Positive for Drugs

Once administered, remifentanil flips switches in the body and brain known as mu-receptors, according to the U.S. National Library of Medicine. Mu-receptors sit within networks of cells that regulate pain in the body. Opioid drugs can relieve pain by tampering with the signals that race through this circuitry. 

But cells bearing mu-receptors also link up to the brain's reward system and can spark feelings of intense pleasure, or euphoria, according to the National Institute on Drug Abuse. Opioid users can get hooked on this euphoric experience, develop drug cravings and dependence over time, and continue taking the drug to avoid withdrawal symptoms as their tolerance builds. 

"However, that's not to say that addiction is solely driven by the amount of pleasure," said Brian Kiluk, a clinical psychologist and psychiatry professor at Yale School of Medicine, who was not involved with the new study. "Not everyone experiences the same level of euphoria from opioids, and not everyone that uses opioids will develop an addiction or opioid use disorder," Kiluk told Live Science in an email. Scientists are still unpacking exactly why individuals react differently to the drugs, he said.

But so far, most opioid research has been conducted with current or former addicts as participants, Leknes said, with some studies going so far as to only include participants who say they enjoy taking the drugs. This bias in the literature may make opioid-induced euphoria seem commonplace, Leknes said, but she wondered whether the average healthy person finds bliss while hooked to an opioid drip. 

So, Leknes and her colleagues studied how 160 patients reacted to remifentanil before undergoing minor surgery. Study co-author Gernot Ernst, an anesthesiologist and neurobiologist at the University of Oslo and Kongsberg Hospital in Norway, asked the participants to rate how good and how anxious they felt before the drug was administered. 

One to 2 minutes after the infusion, the drug took full effect, and Ernst asked the same questions again, as well as how much the patients "liked" the drug effects, what level of drug-related discomfort they experienced and how high they felt. Leknes once received the same dose as part of a different study and recalled feeling as though the room were "spinning" as a wave of warmth rushed through her body. 

Across the board, the patients reported feeling high after receiving remifentanil, but on average, they actually felt 0.5 points worse on a 10-point scale after taking the drug. In other words, the high they felt was unpleasant rather than euphoric. This dip in well-being appeared steeper in individual patients who had never taken opioids before, Siri said. Both ratings of liking and disliking the drug effects hovered around 5 on the 10-point scale. 

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A small subset of people did report feeling slightly better after the drug was administered, but even these participants still gave the experience a 5 out of 10 on the "liking" scale. In other words, clearly no one reached euphoria on the operating table in the course of the study.

A 2008 study backs these preliminary findings, having found that infusions of remifentanil left healthy volunteers feeling negative and ill at ease rather than euphoric. Recent studies of other common opioids, such as oxycodone, have also challenged the idea the drugs cause most people to experience pleasure, showing instead that many participants disliked the drug effects. In previous work, Leknes' lab found that the opioid morphine only modestly improves a healthy person's mood — when it elicits any change at all. 

Of course, anecdotally, Leknes said some patients report enjoying their opioid high on the operating table. Some describe the sensation as similar to a "champagne feeling," referencing the sensation of getting a teeny bit tipsy after drinking sparkling wine. "But we don't seem to have captured any of those people in this study," Leknes said.

While no participants reached joyous rapture in Leknes' investigation, a different 2019 study, published in the British Journal of Anaesthesia (BJA), suggests that taking remifentanil may make other experiences, like watching a movie, more pleasurable in the short term. The drugs also appear to suppress negative responses to stimuli while boosting positive ones, which "may be one of the reasons behind the first opioid experiences developing to an opioid use disorder," the authors wrote.  

"Pleasure-seeking individuals might be interested in taking another dose of an opioid if available, which in the long run might then lower the threshold to continuous opioid use," Tarja Heiskanen, a specialist in anesthesiology at the Hospital District of Helsinki and Uusimaa in Finland and co-author of the BJA paper, told Live Science in an email. However, limitations of the BJA paper make it impossible to say that remifentanil was truly behind the reported pleasurable experiences, according to Leknes.      

Going forward, Leknes aims to learn how the effects of opioids change, depending on a person's current mood and setting. For instance, while some people first encounter opioids in a sterile, scary clinical setting, college students "generally seem to take opioids before going out," she said. Both sets of people may run the risk of developing an opioid addiction, but their roads to dependence likely diverge. How does euphoria fit into each experience?      

"I think it's especially important to point out that opioids do not reliably cause pleasure or relief of subjective stress and anxiety in the lab or in stressful clinical settings," Leknes added in an email to Live Science. Doctors can't assume that an opioid will calm their patient on the operating table, and models of opioid addiction should acknowledge that not everyone begins abusing the drug in search of euphoria, she said. 

"The notion that people become addicted to drugs because they initially chose to take these drugs for pleasure is a belief that stems from a different time, in which we believed addiction to be a moral issue rather than a medical one." 

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Originally published on Live Science. 

Half a dozen cancer patients in New York developed a rare infection after they received injectable opioids that a nurse had diluted with tap water, according to a new report.

It appears that the nurse tampered with the syringes to remove some of the narcotics for her own use, replacing the drugs with water, the report said.

The patients became infected with a bacterium called Sphingomonas paucimobilis and were treated with antibiotics. No deaths resulted from the infections, but some patients later died from unrelated causes, including complications of cancer, according to the report, published today (Aug. 7) in the The New England Journal of Medicine. [27 Devastating Infectious Diseases]

The issue came to light in the summer of 2018, when six patients at Roswell Park Comprehensive Cancer Center in Buffalo, New York, developed bloodstream infections with S. paucimobilis. This bacterium lives naturally in soil and water, but it rarely causes bloodstream infections, even among people with weakened immune systems, the report said.

Because these infections are so rare, doctors suspected a contaminated medication was behind the outbreak. Indeed, an investigation revealed that syringes of hydromorphone, an opioid medication, tested positive for S. paucimobilis.

What's more, hydromorphone syringes that were stored in a locked drawer that was part of the hospital's automated medication-dispensing system also tested positive for S. paucimobilis and other waterborne bacteria.

Records showed that a nurse had "repetitively and inappropriately" accessed this storage drawer, the report said.

Although the syringes showed no overt signs of tampering, tests revealed that the medications in the syringes had been diluted with water.

"We concluded that a portion of the narcotic had been removed and replaced with an equal volume of tap water, which contaminated the [medication] with waterborne bacteria," the report said.

In other words, the outbreak was tied to "drug diversion," which happens when a person illegally uses medications meant for someone else — in this case, medication meant for cancer patients.

"We share our experience to alert health care providers that, in this age of profound prevalence of opioid addiction, drug diversion is an important consideration when a cluster of waterborne bacteremia [bloodstream infection] is identified," the report concluded.

The hospital notified staff about the outbreak and contacted patients who were at risk for exposure. Roswell Park also notified the N.Y. State Department of Health as well as law enforcement, so it could conduct an investigation.

The new report did not identify the nurse. But in June of this year, James P. Kennedy Jr., the U.S. attorney of the Western District of New York, announced that a former nurse at Roswell Park had been charged with stealing pain medications and so faces up to 10 years in prison and a $250,000 fine.

According to the criminal complaint, that nurse, Kelsey Mulvey, is accused of using her position to tamper with and steal vials of medication, including hydromorphone. Mulvey allegedly accessed the hospital's automated medication-dispensing system even on her days off and in hospital wings where she was not assigned patients. Mulvey is accused of failing to properly give medications to 81 patients between February and June 2018. She resigned her position in July 2018.

Prosecutors allege that the nurse had an addiction and took the narcotics for personal use, according to The Buffalo News, a local newspaper.

"Once again, this case illustrates the destructive power of opioid addiction," Kennedy said in a statement. "In this case, however, the harm caused by defendant's actions resulted not only in harm to herself but in harm to some of the most compromised and vulnerable individuals in our community — those members of our community receiving cancer treatments."

Roswell Park first disclosed the incident to the public in September 2018, The Buffalo News reported.

Since that time, the hospital has taken more steps to prevent drug diversion, including enhancing security surveillance with video monitoring, reviewing current hospital policies, and increasing staff training and education on drug diversion, according to The Buffalo News.

In April of this year, the Centers for Disease Control and Prevention reported that a nurse in Washington state likely infected at least a dozen patients with hepatitis C after she used injectable opioid drugs that were meant for patients.

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Originally published on Live Science.

The marijuana compound CBD, or cannabidiol, may help reduce drug cravings in people with heroin addiction, a preliminary new study suggests.

The study, which is published today (May 21) in the American Journal of Psychiatry, involved 42 people with heroin-use disorder who were attempting to abstain from the drug.

Participants visited the laboratory and were shown "cues" intended to trigger a drug craving — in this case, videos of people using heroin, or objects involved in drug use, like syringes. (Seeing these types of "cues," in an uncontrolled setting, can contribute to drug relapse, the authors said.) Before their lab session, participants received either a dose of CBD or a placebo.

Participants who received CBD reported experiencing lower drug cravings in response to the cues, as well as lower anxiety, compared with those who received a placebo. What's more, the effects appeared to be somewhat durable, lasting up to a week after participants took CBD. [Mixing the Pot? 7 Ways Marijuana Interacts with Medicines]

Still, the results are far from definitive — the researchers did not examine whether CBD actually prevents drug-relapse outside of a laboratory setting, and so future studies are needed to answer this question.

But the new findings suggest that "CBD holds significant promise for treating individuals with heroin use disorder," study lead author Yasmin Hurd, director of the Addiction Institute at the Icahn School of Medicine at Mount Sinai in New York, said in a statement.

CBD has received a lot of attention in recent years for its potential to have therapeutic effects without producing the "high" typically associated with marijuana. But so far, the Food and Drug Administration (FDA) has only approved CBD in prescription-drug form for treating rare types of childhood epilepsy.

Hurd stressed that self-treatment with CBD for opioid use disorder is not advised at this time, and might even be harmful given that non-prescription forms of CBD are not regulated. "A lot of CBD that is available to the public…[has] inaccurate information as to what is actually in the container, and may even be contaminated with toxins," Hurd told Live Science.

The study was funded in part by GW Pharmaceuticals, which makes the FDA-approved form of CBD.

'Urgent need' for treatments

Currently, most drug treatments for opioid use disorder act on opioid receptors, and thus come with their own addiction risk. As a result, they are tightly regulated by the government. In light of the opioid epidemic, there is an "urgent need" to develop treatments for opioid addiction that do not act on opioid receptors, the authors wrote in the study.

Previously, Hurd and colleagues studied CBD in animal models, and found that CBD reduced heroin-seeking behavior in the animals in response to "cues" intended to trigger a craving. The researchers also conducted early studies in people to determine that CBD is safe to take together with opioids.

In the new study, the 42 participants were randomly assigned to one of three groups, which took 400 milligrams of CBD once daily, 800 mg of CBD once daily, or a placebo once daily, for three consecutive days. (Participants in the CBD groups received Epidiolex, the FDA-approved prescription drug.) The study was "double blind," meaning that neither the researchers nor the subjects knew whether they had received CBD or a placebo.

After participants took their dose of CBD or placebo, they were exposed to heroin-related "cues;" and later watched a "neutral" video showing relaxing scenarios, such as scenes of nature.

As expected, participants reported higher cravings after viewing the heroin-related cues compared with the neutral videos. But if participants received CBD before their session, their cravings were significantly reduced compared with those who received a placebo, the study found.

The researchers also saw reductions in anxiety, as well as physiological measures, including heart rate and levels of the "stress hormone" cortisol, in the CBD group compared with the placebo group.

The effects were seen as soon as 1 hour after the CBD dose, and up to one week later. The latter finding suggests that CBD may still have an anti-craving effect when little to no trace of the substance remain in people's systems, the authors said.

Future research

Dr. Harshal Kirane, director of Addiction Services at Northwell Health's Staten Island University Hospital, called the work "a step in a very encouraging direction," and applauded the effort to scientifically evaluate the effects of CBD.

However, Kirane said the study had some important limitations. Since it was a small study, the results need to be replicated in a larger group of people, he said.

And although the study found that CBD reduced cravings in the laboratory, it did not reduce self-reported cravings outside of the laboratory as measured by a take-home questionnaire.

"That raises some concerns as to what the actual real-world application of CBD could be" for these patients, Kirane told Live Science. Studies also need to evaluate the long-term effects of CBD for these patients, beyond one week, he said.

Future research should examine whether CBD may work as a supplement to current therapies for opioid use disorder to enhance their effects, Kirane said. Indeed, Hurd told Live Science that one of the next steps of the research is to study CBD as an adjunct therapy to current medications, such as methadone or buprenorphine.

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Originally published on Live Science.

In April, the TV news program "60 Minutes" aired a report about fentanyl, a synthetic opioid much more potent than heroin that's been implicated in thousands of overdose deaths in the United States. During one segment, Justin Herdman, a U.S. Attorney in Cleveland, wore gloves as he showed journalist Scott Pelley seized bags of fentanyl and carfentanyl (also spelled carfentanil), an even stronger analogue of the drug, in their powder form.

"So if you touch this stuff, it could kill you?" Pelley asked. Herdman replied, yes.

"There's a reason we have a medic standing by, Scott, and that's because an overdose is — unfortunately it's something that we have to be prepared for, even dealing with it in an evidence bag," Herdman said. [How Does Anesthesia Work?] 

Fentanyl is highly potent, but to experts in the medical community, the segment was a misguided claim about the danger of simply being in the same room the drug.

Dr. Ryan Marino, a toxicology fellow who specializes in emergency medicine at the University of Pittsburgh School of Medicine, recently started using the hashtag #WTFentanyl to call out such news stories that promote fentanyl myths.

"I just hope that people can use a little more critical thinking," Marino told Live Science.

Despite occasional news stories about police officers and other first responders experiencing ill effects or needing Narcan, an opioid antidote, after exposure to fentanyl, Marino said he doesn't know of any verified medical cases of a first responder testing positive for fentanyl through mere skin contact or being in the vicinity of the drug. And overdosing in such a scenario seems highly unlikely based on what researchers know about fentanyl and other opioids, he said.

In its guide for emergency responders, the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) say that for opioid toxicity to occur, "the drug must enter the blood and brain from the environment." For this to happen, the drug would need to be absorbed by a mucous membrane (such as the nasal passages), inhaled, ingested or delivered by a syringe. Fentanyl can also enter a person's system therapeutically through dermal patches, but it takes several hours to absorb. 

"[B]ased on our current understanding of the absorption of fentanyl and its analogs, it is very unlikely that small, unintentional skin exposures to tablets or powder would cause significant opioid toxicity, and if toxicity were to occur, it would not develop rapidly, allowing time for removal," the guide says.

Fentanyl also isn't volatile, meaning it doesn't readily vaporize or get into the air if undisturbed. In an extreme circumstance in 2002, when Russian authorities used an aerosol suspected to contain carfentanyl and remifentanil — a short-acting synthetic opioid — to subdue hostage-takers of a Moscow theater; more than 100 people were killed due to exposure to this gas. However, the AACT/AACT guide also notes, an "optimized airborne dispersal device is unlikely to be encountered in a local event."

In a December 2018 article in the health news publication STAT, medical toxicologists Drs. Lewis Nelson and Jeanmarie Perrone, noted that immediately following that 2002 incident, rescuers wearing limited or no protective equipment carried the victims from the theater, but weren't affected by the opiods. "Passive toxicity makes even less sense in conventional drug-use settings where other individuals are present and unaffected," Nelson and Perrone wrote.

Marino said he thinks myths about fentanyl risk are harmful in three ways. First, misguided fear over the drug may further stigmatize drug users, and prevent people who overdose from being resuscitated or getting the care they need. There is a genuine opioid crisis, with rising deaths among drug users being attributed to fentanyl; overdose is a time-sensitive condition, and delaying treatment can be fatal.

Second, first responders who start feeling ill at the scene of an overdose or a drug call might not be getting appropriate care and support. "I don't want to say that the symptoms that they're having aren't real," Marino said, but often "the symptoms do not match up" with overdose and it's possible that they're instead experiencing "nocebo" effects (the negative counterpart of the placebo effect) or panic attacks. (The symptoms of opioid toxicity are slowed breathing, decreased consciousness and very small pupils.)

Third, myths about illicit fentanyl might create unnecessary fear about the legitimate uses of the drug. Fentanyl is commonly administered in hospitals to alleviate extreme pain for people with broken bones, for example, Marino said. The drug is handled frequently by pharmacists, surgeons, nurses and anesthesiologists without the negative, passive side-effects that are being reported in these news stories.

In a guide that Marino made for first responders, he wrote that proper precautions, such as wearing gloves and washing any skin exposed to fentanyl with water (not with alcohol-based hand sanitizers, which could increase absorption) can help to protect them from exposure to the drug. If desired, wearing a N95 mask in situations where there is extreme air movement can also reduce the risk of exposure, he said.

Editor’s Note: This article was updated to include information about fentanyl transdermal patches.

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Originally published on Live Science.

A nurse in Washington state likely infected at least a dozen patients with hepatitis C after she used injectable drugs that were meant for patients, according to a new report.

Health officials began investigating the outbreak early last year, when two patients developed hepatitis C between January and March 2018 after being treated at the same emergency room near Tacoma, Washington. Neither of the patients had typical risk factors for hepatitis C, but both had received injections of opioid drugs while in the ER, and were treated by the same nurse, according to the report, published this week by the Centers for Disease Control and Prevention (CDC).

The two patients also had genetically identical strains of hepatitis C, meaning that they were infected from the same source. (Hepatitis C is a liver infection caused by the hepatitis C virus, according to the CDC. Symptoms can include fever, fatigue, abdominal pain, nausea and jaundice – yellowing of the skin and/or eyes.) [27 Devastating Infectious Diseases]

Curiously, officials found that the nurse had accessed the hospital's automated drug-dispensing system at a much higher rate than other nurses had. She also tested positive for hepatitis C, and admitted "diverting" patient's drugs for her own use, the report said.

The nurse didn't say exactly how she diverted the drugs. In previous cases of people who contracted infections from health care workers, the workers first injected themselves with the patients' drugs and then refilled the syringe with water before injecting that into the patients, the report said. The nurse in this case may have also used part of the dose, and given the rest to the patient, using the same syringe.

After discovering the outbreak, officials reached out to nearly 3,000 people who had received injectable drugs at the hospital's emergency room during the time that the nurse worked at the facility (regardless of whether or not they were treated by the nurse.)

Of these, 13 people who were treated by the nurse tested positive for hepatitis C; all of them had strains of the virus that genetically matched the nurse's strain of the virus.

Among these patients, 12 had only recently developed hepatitis C; the other patient had a known chronic infection. The nurse in question may have acquired the virus from the patient with the chronic infection (who was treated at the hospital in November 2017), and subsequently infected the other 12 patients, the report said.

"Drug diversion by healthcare providers can pose serious infection risks for patients," the report said. "Health care facilities need to develop security measures and to actively monitor drug dispensing systems to detect and prevent narcotics and other drug diversion."

After identification of the outbreak, the nurse's license to practice was suspended.

The hospital affected wasn't named in the report, but last year, MultiCare Good Samaritan Hospital in Puyallup, Washington, issued a statement that acknowledged the outbreak investigation and apologized to patients who were infected.

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Originally published on Live Science.

Poppy farmers in the state of Madhya Pradesh in India have reportedly run into some trouble while cultivating this season's crops. In addition to inconsistent rainfall putting a damper on things, flocks of persistent parrots — presumed to be addicted to opium — are rampaging through the poppy farms, sometimes making 40 visits a day to get their fix.

"One poppy flower gives around 20 to 25 grams of opium. But a large group of parrots feed on these plants around 30 to 40 times a day," one poppy cultivator in the Neemuch district of central India told Indian news site NDTV.com. "This affects the produce. These opium-addicted parrots are wreaking havoc."

According to NDTV, bird raids have become a daily menace in the poppy fields, and farmers claim to be sustaining significant crop losses thanks to these poppy-seeking parrots. Some birds have been filmed tearing into unripe poppy pods (where opium-rich milk resides), while others use their beaks and claws to snip off the plants at their stalks and fly away with entire intact pods. The Daily Mail reported that some birds have even trained themselves not to squawk when descending on the fields, swooping in and out like silent ninjas. [9 Weird Ways You Can Test Positive for Drugs]

District officials have ignored requests to help keep the feathered menace in check, the farmer told NDTV, leaving poppy purveyors to fend for themselves. Some cultivators have been forced to guard their fields day and night. Others have reportedly turned to sonic warfare, shouting at the birds through loudspeakers or detonating firecrackers in their vicinity. Unfortunately, the farmer said, these attempts have failed to mitigate crop losses.

Poppy-thieving birds are not a new occurrence in India, which is one of the few places in the world where licensed opium cultivation is allowed, according to India Today magazine. Bird raids have been reported several years in a row in multiple poppy-cultivating districts, sometimes leaving the pilfering parrots visibly intoxicated. According to a 2018 article in DNA India, the opium-munching birds were observed crashing into tree branches and "lying in the fields in a daze," only to fly off again when the narcotic effects wore off.

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Originally published on Live Science.

Rates of a serious birth defect are on the rise in the United States, and a new report suggests the condition may be linked to opioid use.

The report, published Jan. 17 by researchers at the Centers for Disease Control and Prevention, looks at cases of gastroschisis, a birth defect in which a baby is born with his or her intestines outside the body, due to a hole in the abdominal wall. Surgery is required to place the intestines back in the body and to repair the hole, but even after this treatment, infants may have problems with digestion, eating and food absorption, according to the CDC. The cause of the condition is usually unknown, but mothers younger than 20 are thought to be at higher risk than older mothers.

The new report analyzed information on gastroschisis cases in 20 U.S. states and found that the rate of gastroschisis increased 10 percent from 2006 to 2010, to 2011 to 2015. Specifically, the report found that the rate of gastroschisis rose from 4.2 cases per 10,000 live births in 2006 to 2010, to 4.5 cases per 10,000 live births in 2011 to 2015. The largest increases were seen in babies born to mothers in their 20s and 30s. [7 Baby Myths Debunked]

The new report follows an earlier study that found that the rate of gastroschisis also increased between 1995 and 2012.

The reason for the increase is not known, but the new report hints at a link to the opioid epidemic. The researchers found that the prevalence of gastroschisis was 1.6 times higher in counties with high rates of prescription opioid use, compared with counties with low prescription opioid rates.

Still, the researchers noted that the study only found an association, and cannot prove that opioid use causes gastroschisis. The study examined opioid use and gastroschisis rates only at a population level, and did not have information on whether women who had babies with gastroschisis were exposed to opioids.

Dr. Saima Aftab, medical director of the Fetal Care Center at Nicklaus Children's Hospital in Miami, who was not involved in the study, said that this rise in occurrences of gastroschisis is concerning. And the fact that rates are rising not only in women under 20, who are thought to be at highest risk, but also in older age groups is "even more alarming," Aftab told Live Science. This suggests that "there's something changing" about the usual patterns of gastroschisis epidemiology.

Aftab noted that she and her colleagues have also noticed an increase in gastroschisis cases in their hospital's fetal program, even in the last six months.

Gastroschisis is a serious condition that can cause swelling, twisting and damage to the baby's intestines before birth, Aftab said. Even after surgery, it may take weeks for the bowels to start functioning, and babies may be in the neonatal intensive care unit (NICU) for months, she said.

The link to opioids seen in the new report is an interesting signal, said Aftab, though she also cautioned that the report cannot determine causality.

But "it does guide where we need to direct our research and how we can answer these questions," she said. For example, basic science studies in animals can look at whether opioids disrupt blood vessels or the bowel tissue when taken during pregnancy. And researchers can also look at whether there's a link among high-risk populations of women who use opioids in pregnancy.

"Having a better understanding of all possible effects of opioid use during pregnancy can help provide evidence-based information to health care providers and women about the potential risks to the developing fetus," the report concludes.

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Originally published on Live Science.

Drug overdose death rates in women in the United States have increased by 260 percent in the past two decades, according to a new report.

The authors of the report, published today (Jan. 10) by the Centers for Disease Control and Prevention (CDC), described the drug overdose death rates among women as "unacceptably high," underscoring the need for targeted efforts to reduce the number of drug overdose deaths among women.

The researchers looked at overdose death rates among U.S. women ages 30 to 64 from 1999 to 2017. In 1999, there were 6.7 overdose deaths per 100,000 women, or 4,314 total overdose deaths, according to the report. By 2017, that rate had risen to 24.3 deaths per 100,000 women, meaning 18,110 women in the selected age group died from an overdose that year. [America's Opioid-Use Epidemic: 5 Startling Facts]

The rates of opioid overdose deaths among women ages 30 to 64 increased by 492 percent, from 2.6 deaths per 100,000 women in 1999 to 15.5 deaths per 100,000 women in 2017, according to the report. The largest increase was for deaths involving synthetic opioids such as fentanyl (a rise of 1,643 percent), followed by heroin (915 percent) and prescription opioids (485 percent).

Drug overdose death rates increased for other drugs as well, including cocaine, benzodiazepines and antidepressants.

Age shifts

The largest increase in overdose death rates over the study period was found among women ages 55 to 64, where rates rose by nearly 500 percent from 1999 to 2017. Overdose death rates also rose in women ages 35 to 39 and 45 to 49 by approximately 200 percent, and in women ages 30 to 34 and 50 to 54 by 350 percent.

In 2017, overdose death rates were highest overall among women ages 50 to 54. That year, the overdose death rate was 28.2 deaths per 100,000 women in that age group. In 1999, the highest rate was found in women ages 40 to 44, at 9.6 deaths per 100,000 women.

The researchers also found that the average age of overdose death among women increased by 2.8 years, from 43.5 years in 1999 to 46.3 years in 2017. What's more, the average age of women dying from drug overdoses increased for every drug class with the exception of synthetic opioids. This finding is further supported by previous studies that have found a recent increase in overdose deaths and drug-related emergency department visits for women ages 45 to 64, the researchers wrote.

Study limitations

The report is based on data from the National Vital Statistics System, a database of death certificates in all 50 U.S. states and the District of Columbia. Only deaths in which the underlying cause was drug overdose were included in the report. Cases where more than one drug was listed as a cause of death were counted in multiple categories — for example, if a death certificate mentioned both heroin and cocaine as a cause of death, the researchers would count it as one heroin overdose death and one cocaine overdose death. What's more, certain overdose deaths may be the result of the combination of drugs used, the researchers noted.

The researchers also noted that estimates of the drugs involved in overdose deaths can be affected by how each death was investigated. For example, they noted, toxicology testing can't distinguish whether a person who died from a fentanyl overdose had taken pharmaceutical fentanyl or illegally manufactured fentanyl. In addition, changes in testing over time — for example, the decisions to test for a wider range of substances — could lead to some of the increases described in the report.

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Originally published on Live Science.

Nine people in San Diego recently developed a rare but serious illness called wound botulism after using black tar heroin, according to a new report from the Centers for Disease Control and Prevention (CDC).

The outbreak has health officials warning doctors and the public to be aware of this condition, which is tied to injection drug use.

Wound botulism occurs when a bacterium called Clostridium botulinum — the same germ that causes botulism from contaminated food — gets into a wound and produces a toxin, according to the CDC. The toxin attacks the body's nerves and can cause breathing difficulties, muscle paralysis and death, the CDC says.

In the United States, there are only about 20 cases of wound botulism diagnosed each year, and in San Diego, only about one case is reported each year. So, when San Diego health officials saw that two people had contracted wound botulism in just one week in September 2017, they sent out an alert to doctors and launched an investigation to see if there were more cases. [10 Interesting Facts About Heroin]

Ultimately, health officials identified nine cases of wound botulism that occurred between September 2017 and April 2018, according to the new report, published in the Jan. 4 issue of the CDC journal Morbidity and Mortality Weekly Report. All of the patients injected drugs, and seven of the patients specifically reported injecting black tar heroin, a dark and sticky form of the drug that is crudely processed and often contaminated with other substances. Six patients reported having injected black tar heroin under their skin in a practice called "skin popping," which is linked with wound botulism infections.

The most common symptoms of the infection were muscle weakness, difficulty swallowing and blurred vision. Wound botulism can be treated with an antitoxin, but it's important to provide prompt treatment to prevent life-threatening complications.

All of the patients in the San Diego outbreak were admitted to intensive care units at nearby hospitals, but one patient ultimately died.

It's unclear exactly why black tar heroin increases the risk of wound botulism, the CDC says. But C. botulinum is found in soil and may get into black tar heroin when the drug is produced or transported. For example, the drug is sometimes transported inside car tires, where it might be contaminated with the bacteria, the report said.

As heroin use in the U.S. rises, along with that of other opioids that contribute to the opioid epidemic, there may be an increase in cases of wound botulism, the CDC said. As such, "there is a growing need for awareness of the risks and symptoms of wound botulism," the report said.

Diagnosing wound botulism can be challenging, in part because symptoms of the illness can overlap with signs of opioid intoxication or overdose. Indeed, in the San Diego outbreak, four of the nine patients initially had their symptoms attributed to drug intoxication, and two were treated with opioid overdose medication, the report said.

People who inject drugs should be aware that wound botulism is a risk, particularly if they use black tar heroin, and doctors who treat injection drug users should be on the lookout for symptoms of wound botulism in their patients, the report concluded.

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Originally published on Live Science.

Not only do prescription opioid drugs come with a risk of addiction and overdose, but they also appear to provide little benefit for patients with chronic pain, according to a new study.

The study found that for people with chronic pain that's not caused by cancer, prescription opioid drugs were tied to only small improvements in pain, physical functioning and sleep quality, compared with a placebo.

What's more, prescription opioids were found to have similar pain-relief benefits as non-opioid treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDS).

Given that prescription opioids are linked with serious risks, including addiction, overdose and death, and that other therapies may provide similar benefits, "our results support that opioids should not be first-line therapy for chronic noncancer pain," lead study author Jason Busse, an associate professor and researcher at McMaster University's Michael G. DeGroote Institute for Pain Research and Care, said in a statement.

The study was published today (Dec. 18) in the journal JAMA.[America's Opioid-Use Epidemic: 5 Startling Facts]

Though opioids have been widely prescribed to treat chronic pain, exactly how much patients benefit from these drugs, and whether the benefits outweigh the risks, has been unclear.

In the new study, a meta-analysis, the researchers analyzed information from 96 previous clinical trials of prescription opioids for chronic, noncancer pain; that included more than 26,000 people in total. In each trial, participants were given an opioid drug, a non-opioid treatment or a placebo. Participants were followed for at least one month.

The meta-analysis found that, compared with a placebo, 12 percent more patients treated with opioids experienced pain relief, 8 percent more had improvements in physical functioning and 6 percent more had improvements in sleep quality.

"These are very modest effects," Busse said. Opioids were not linked with improvements in social or emotional functioning, the study further found.

In addition, any benefits of opioid drugs waned over time, the results showed. But in real life, doctors often increase the dose of opioid drugs when patients don't experience pain relief, Dr. Michael Ashburn and Dr. Lee Fleisher, both of the University of Pennsylvania's Department of Anesthesiology and Critical Care, wrote in an editorial accompanying the study. "Given the clear risk of serious harm, opioids should not be continued without clear evidence” that they are working for a given patient, the editorial authors wrote.

The study also analyzed information from nine clinical trials involving more than 1,400 people that specifically compared opioid drugs with NSAIDs. Results showed that people who received opioid drugs reported about the same amount of pain relief as those who received NSAIDS, demonstrating, in other words, that NSAIDs appear to work just as well for pain relief.

In light of the opioid epidemic, doctors around the country have been making efforts to reduce prescriptions of the drugs. And these efforts may be working; in 2017, the number of people who misused prescription opioid drugs decreased by an estimated 400,000 and the number of people who started using heroin decreased by an estimated 89,000, compared with 2016, the editorial said.

However, 2017 was the deadliest year for opioid overdose deaths, according to the Centers for Disease Control and Prevention. Fentanyl, a powerful synthetic opioid, was largely responsible for the increase in deaths.

The editorial noted that opioids may still be a safe and effective treatment for carefully selected patients if those individuals are properly monitored over time. But "it is time for physicians to redouble efforts to improve the process of care when prescribing opioids," including diligently monitoring patients and avoiding overprescribing, the editorial concluded.

• 5 Surprising Facts About Pain
• 9 Weird Ways You Can Test Positive for Drugs
• 10 Interesting Facts About Heroin

Originally published on Live Science.

Humans have been turning to the poppy plant to get high or relieve pain for thousands of years. And despite all our other staggering pharmaceutical progress, our reliance on the plant hasn't changed much; poppies are used to make two of the world's most widely used painkillers, morphine and codeine, and the cough suppressant noscapine.

But how did the opium poppy plant (Papaver somniferum) get its pain-relieving properties to begin with?

A team of researchers in the United Kingdom, China and Australia has been digging into this question for the past several years, examining the opium poppy genome to figure out how this plant developed its unusually potent and useful therapeutic properties. Now, a new study, published today (Aug. 30) in the journal Science, details the majority of the opium poppy genome. The study highlights when and how the key pharmaceutical-producing genes came into play. [10 Interesting Facts About Heroin]

The task was difficult, thanks to the plant's abundance of genetic material that contains several repeated sections. Still, piecing together the genome was helpful for tracking the opium poppy's development.

The first important poppy genetic event, the researchers found, took place about 110 million years ago. That was when the entire genome, or at least very large chunks of it, duplicated. This isn't unusual for angiosperms, the category of flowering plants that includes poppies. But the duplication can be consequential. When organisms have double the genetic material, one half of the genome is free to evolve, while the other half remains stable, said study co-author Ian Graham, a biomedical genetics professor at the University of York in the United Kingdom.

In the case of poppies, that extra genetic material evolved in one very important way, the researchers found: More than 7.8 million years ago, two genes fused and became the single gene responsible for poppy's morphine and codeine production. This "megagene" codes for an enzyme that converts a precursor poppy molecule into the compounds that eventually become codeine and morphine. Without it, poppies would just transform that same precursor molecule into the compound noscapine, and the plants wouldn't be painkillers.

To Graham, this is one of the most important finds in their research. "It's really satisfying to know how that gene has arisen," he told Live Science.

After that gene fusion, the poppy genome replicated again and lost some pieces, the study found. But the megagene crucial for forming opiatesstuck around. Like with most useful genes, odds are that this gene was a random mutation that kept getting passed on because it was useful to the plant. It's not totally clear to biologists why opium poppies kept their morphine- and codeine-producing skills around, but it's likely because the chemicals ward off hungry herbivores, Graham said.

Some other poppy mysteries remain to be solved, too. For example, the other enzymes involved in producing morphine and codeine probably appeared earlier than the megagene's arrival 7.8 million years ago, though the research team doesn't know when exactly. (In other words, the megagene isn't the only player involved in painkiller production in poppies.) Graham said that he also hopes to study the genomes of related plant species to see why some of them do or don't make narcotics.

But for now, deducing how poppies got their medicinal qualities, and what the genome looks like, is enough to help the painkiller industry, Graham said. (Despite abuse of opioids, there's still a need for quality painkillers and palliative care drugs, he added.) Even though horticulturalists have developed hyper-specific strains that mostly produce the opiates or noscapine, opium poppy growers are always looking for ways to make production more sustainable and cost-effective, he said.

And like any other crop, there might be room for genetic modifications to make the poppies produce more of the pharmaceutical agents, grow faster or withstand infection. "Genome analysis provides us with a platform to do all of that more effectively," Graham said.

Originally published on Live Science.

With the opioid epidemic raging across America, many scientists are in search of an alternative painkilling drug — one that could be used in place of opioids, without the deadly side effects.

Now, a team of researchers in the U.S. and Japan say they've developed a promising new synthetic drug that could be as effective as opioids in relieving pain but without posing the risk of addiction. In a new study, the drug, called AT-121, successfully relieved pain in rhesus monkeys without resulting in harmful side effects or causing the monkeys to become addicted. Still, more research is needed before the drug could be evaluated in humans.

"I think this is pretty interesting," said Dr. Bryan Roth, a professor of pharmacology and a physician at the University of North Carolina at Chapel Hill, who was not involved in the study. "The results are really clear-cut, but there are a few things that still need to be done before it can ultimately go forward," he said.  

Although the number of opioids prescribed in the U.S. has decreased since its peak in 2010, the levels remain high. The Centers for Disease Control and Prevention (CDC) found that there were more than 42,000 deaths from opioid overdoses in 2016, up from 33,000 deaths in 2015, Live Science previously reported. [America's Opioid-Use Epidemic: 5 Startling Facts]

"It's a huge problem. I don't think anyone disagrees about that," Roth told Live Science.

A new drug candidate

AT-121 is considered a bifunctional drug, according to the study, which means it targets and prohibits the function of two specific opioid receptors in the brain that inhibit the sensation of pain: the mu-opioid peptide (MOP) receptor and the nociceptin/orphanin FQ peptide (NOP) receptor. Similar drugs have been studied in experiments with mice, and although those medicines effectively relieved pain, they were found to be addictive and therefore were not viable alternatives to existing opioid painkillers.

"This is the first [painkiller drug] demonstrated in a nonhuman [primate] model to have such a promising profile," co-senior study author Mei-Chuan Ko, a professor of physiology and pharmacology at Wake Forest University in North Carolina, told Live Science.

The team tested the drug in 15 adult male and female rhesus monkeys (Macaca mulatta). Through a series of experiments, the researchers determined that monkeys given AT-121 didn't feel pain and didn't experience the typical side effects associated with similar drugs.

"The pain relief that was observed in the [animal experiments] was similar to that of morphine, yet the dose of AT-121 that was used was 100-fold lower than that of morphine," said co-senior study author Nurulain Zaveri, the president and chief scientific officer at Astraea Therapeutics, a pharmaceutical company involved with the study.

Not only did the drug relieve pain, but the monkeys also didn't become dependent on it. When the monkeys were given the ability to self-administer AT-121, by pressing a button, they repeatedly chose not to do so. This suggests that AT-121 doesn't produce a rewarding or reinforcing effect that would lead to addiction, at least in this short-term experiment.

The fact that the drug was studied in a primate model, rather than in a mouse model as is done in many similar studies, means that the effects of the drug are likely much closer to what scientists would expect to see in humans, Roth said. And the monkeys didn't experience any changes in respiratory health while taking AT-121, which suggests that an overdose would be unlikely to cause the harmful or fatal respiratory effects associated with an opioid overdose. "That would be a significant advance if that [result] is transferable to humans," Roth added.

One of the limitations of the study was that it didn't look at what's called "off-target activity," Roth said. This refers to interactions of the drug with other parts of the brain or areas outside the brain. "It's very important to find out — does [AT-121] interact with any other receptors or ion channels or transporters in the body?" Roth said. Such interactions could determine the potential for side effects outside of the ones examined in this study.

The scientists plan to continue their research by carrying out the safety and toxicology studies that are required by the U.S. Food and Drug Administration before proceeding with human clinical trials. "We want to move as fast as possible, because our results are exciting," Zaveri told Live Science. The scientists are also researching other compounds that have a similar profile as AT-121, she added.

"If we can really come up with these new types of compounds, they can potentially reduce a lot of medical burden," Ko said. "I perceive this will have huge impact in our society and global community." 

"This is one of several of these types of studies that have been published recently that suggest there may be hope for creating safe medications for treating pain," Roth said. "It gives me hope for the field that we may be turning a corner."

The researchers published their study today (Aug. 28) in the journal Science Translational Medicine.

Original article on Live Science.

The anesthetic ketamine has drawn excitement in recent years as a fast-acting and effective treatment for severe depression. Now, a small, new study sheds light on exactly how the drug works to treat depression, with a surprising finding: Ketamine needs to activate opioid receptors in order to have antidepressant effects.

The new findings challenge previous views on how the drug works to treat depression, the researchers said. "It doesn't work like everyone thought it was working," co-senior study author Dr. Alan Schatzberg, a professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, said in a statement.

In light of the current opioid epidemic, the findings also underscore the need for caution against the widespread and repeated use of ketamine for depression until more research is done on the drug's mechanism of action and its risk of abuse among patients, the researchers said. "We have to properly examine the risks associated with using drugs of abuse — even in low doses — to treat depression," Schatzberg said. [6 Party Drugs That May Have Health Benefits]

The study was published today (Aug. 29) in The American Journal of Psychiatry.

Ketamine for depression

Ketamine has been used for decades as an anesthetic in hospitals, but it has also developed a reputation as an illegal "club drug," known as "Special K."

In recent years, studies have found that ketamine can have fast and dramatic effects for people with depression, improving symptoms within just hours, rather than the weeks that many other antidepressants take. Given these findings, the drug has emerged as a potentially promising therapy for people with severe depression who haven't been helped by other treatments, with some doctors prescribing the drug "off label" for depression.

Exactly how ketamine works to treat depression isn't known. But researchers suspected the drug's antidepressant effects were due to its ability to block the receptor for a brain chemical called glutamate, which is involved in mood regulation.

But when scientists tried to develop other glutamate-receptor-blocking drugs to treat depression, those efforts largely failed, Schatzberg said.

In the new study, the researchers hypothesized that ketamine works to treat depression at least in part by activating opioid receptors. To examine this possibility, the researchers gave participants the opioid-blocking drug naltrexone before they underwent ketamine treatment.

The study involved 12 patients with depression who had tried at least four antidepressants or other depression treatments but hadn't benefited from them.

All of the participants received an infusion of ketamine twice — once after receiving naltrexone and again after receiving a placebo in place of the opioid-blocker. The two infusions took place about a month apart. Neither the participants nor the researchers knew whether the patients had received naltrexone or the placebo prior to their ketamine treatment.

The study found that when participants received ketamine with the placebo, they experienced a dramatic reduction in their symptoms of depression, but when they received naltrexone, the ketamine had almost no effect on their symptoms of depression.

However, participants who received naltrexone still experienced "dissociative effects" from ketamine, such as hallucinations.

The results were so clear that the researchers stopped the study early to avoid exposing more people to "a clearly ineffective and noxious combination treatment," the researchers said, referring to the ketamine-plus-naltrexone treatment.

Future studies

Because the new study was small, the findings should be confirmed by further research, Dr. Mark George, a professor of psychiatry, radiology and neuroscience at the Medical University of South Carolina, wrote in an editorial accompanying the study. (George was not involved with the new study.)

More research is also needed to examine whether ketamine's antidepressant effects are due to its actions on opioid receptors alone, its combined effect on opioid and glutamate receptors, or another mechanism, George said.

He also urged caution about the use of ketamine for depression. "We would hate to treat the depression and suicide epidemics by overusing ketamine, which might perhaps unintentionally grow the 'third head' of opioid dependence," George said. He likened the problems of opioid use, depression and suicide to the heads of Hydra, the many-headed monster in Greek mythology.

"We need to better understand ketamine's mode of action and how it should best be used and administered," he concluded.

 Original article on Live Science.

The director of the Centers for Disease Control and Prevention revealed why he has a personal stake in fighting the current opioid epidemic: His son almost died from using cocaine laced with the synthetic opioid called fentanyl.

"For me, it's personal. I almost lost one of my children from it," Dr. Robert Redfield Jr. said at the annual conference of the National Association of County and City Health Officials in New Orleans on Thursday (July 12), as reported by the Associated Press.

Redfield, who stepped into the role of CDC director in March, said that the opioid crisis is the "public health crisis of our time" and that it would be one of the agency's priorities.

In 2016, opioids — including prescription opioids such as oxycodone as well as heroin and fentanyl — killed 42,000 people, according to the CDC. That was up from 33,000 opioid-related deaths in 2015.

The CDC researchers attributed much of the increase to the rise in deaths from synthetic opioids not including methadone, which includes the illegally-manufactured fentanyl. Synthetic opioid deaths rose from 9,580 in 2015 to more than 19,000 in 2016, the report showed. [America's Opioid-Use Epidemic: 5 Startling Facts]

On average, in the United States, 115 people die every day from an opioid overdose, the CDC said.

In fact, opioids appear to be shaving time off the average U.S. life expectancy: A report released in September 2017 revealed that opioid-related deaths accounted for 0.21 years of life expectancy lost between 2000 and 2015, according to the report.

In a statement released Monday (July 16) and reported by the AP, Redford said, "It's important for society to embrace and support families who are fighting to win the battle of addiction — because stigma is the enemy of public health."

Fentanyl is 30 to 50 times more potent than heroin, according to the U.S. Drug Enforcement Administration. It's also cheaper than other drugs, offering "a high profit margin for traffickers," the DEA says. As such, manufacturers often mix it into counterfeit opioid pills. Since the substance is more potent than the drugs it's being mixed with, "it only takes a very small amount of fentanyl to cause a severe or potentially deadly reaction. As little as two milligrams is a lethal dosage in most people," the DEA says.

Originally published on Live Science.

From 2007 to 2016, more than 11,000 children and adolescents in the U.S. were exposed to buprenorphine, a drug that's used to treat opioid-use disorders, a new study finds. Of those 11,000, 86 percent were under age 6.

The numbers are based on calls to poison control centers during that time period, according to the study, published today (June 25) in the journal Pediatrics.

Though it's used to treat opioid dependence, buprenorphine is also an opioid. However, it is much weaker than opioids that are typically abused, such as heroin and oxycodone, the study said. [America's Opioid-Use Epidemic: 5 Startling Facts]

The researchers don't know how or why so many children were exposed to buprenorphine, but they think it could have resulted from parents not storing the drugs properly — that is, out of children's reach. Indeed, around 90 percent of the exposures were unintentional, according to the study.

"We're not quite sure why [buprenorphine] stands out so much [to kids]," Henry Spiller, one of the authors of the paper and the director of the Central Ohio Poison Center, told CNN. "Perhaps the parents who have this may not think it's as risky as their other [opioids] because it doesn't have the big effect that the other[s] do for them."

But the drug is dangerous for young children. It "is never prescribed for children under 6," Spiller said. "It is a significant risk to them."

Almost half of the children under age 6 who were exposed to the drug were admitted to the hospital, and 21 percent of them had a serious medical problem, such as a seizure, cardiac arrest, respiratory depression (slow and ineffective breathing) or coma. Seven children under age 6 died as a result of the exposure.

The researchers wrote that manufacturers should use packaging that would make it more difficult for young children to access the pills. In addition, buprenorphine prescribers should talk to parents and child caregivers about the harms of exposure for young children and walk them through how to properly store and dispose of the drugs.

The study also found that about 11 percent of the exposures were in adolescents, and that about 77 percent of those individuals took it intentionally.

Originally published on Live Science.

Marijuana use may affect how much pain people feel and the dose of painkillers they need following a traumatic injury, such as an injury from a car accident, a new study suggests.

The study found that, after experiencing a traumatic injury, marijuana users reported higher levels of pain, and needed higher doses of opioid painkillers, compared with patients who didn't use marijuana.

The researchers stressed that the findings are preliminary, and more studies are needed to confirm the results. But if the results are confirmed, the study could have implications for treating pain in marijuana users — a population that may be growing due to increased legalization of the drug, the researchers said. [Mixing the Pot? 7 Ways Marijuana Interacts with Medicines]

The findings suggest "marijuana users in need of pain control deserve special consideration when selecting the dosage and frequency of narcotics [painkillers]," said study lead author Kristin Salottolo, a clinical epidemiologist at the Swedish Medical Center's Trauma Research Department in Englewood, Colorado.

 The study was published June 19 in the journal Patient Safety in Surgery.

Marijuana and pain

The researchers started the study after treating trauma patients in Colorado who used marijuana routinely, and "were noted to have poor pain control and required higher than normal amount of narcotics," Salottolo told Live Science. "We wanted to see if this anecdotal observation held up" in a scientific study, she said.

The study researchers analyzed information from about 260 people who were involved in motor vehicle accidents between January and April 2016 and who were admitted to trauma centers in Colorado and Texas.

Of these patients, 21 percent (54 patients) reported using marijuana recently or tested positive for marijuana on a drug test, and 6 percent (16 patients) reported daily or near-daily marijuana use. (Marijuana use was reported four times more frequently in Colorado, where the drug is legal for medical and recreational purposes, compared with Texas, where the drug is illegal for both purposes.)

About 9 percent of participants tested positive for prescription or "street" drugs other than marijuana, including amphetamines, barbiturates, benzodiazepines, cocaine, methamphetamine and opiates.

Patients who used marijuana but not other drugs consumed 7.6 milligrams of opioid medications a day while in the hospital, on average, compared with 5.6 milligrams for patients who didn't use marijuana or other drugs.

What's more, when asked to report their level of pain on a scale of 0 to 10 (with 0 being the lowest pain and 10 being the worst), marijuana users had a daily pain score of 4.9, on average, compared with 4.2 for non-marijuana users.

These effects were less pronounced in patients who used other drugs in addition to marijuana, the study found.

More awareness

Dr. Anne Wagner, medical director of the UCHealth Burn Center in Aurora, Colorado, who was not involved in the study, agreed with the findings. Wagner and her colleagues have also conducted research on burn patients that found that those who are heavy marijuana users require "much higher doses of opioids" compared with patients who don't use marijuana.

Using higher doses of narcotics to control pain can lead to many other problems — for example, it means that marijuana users frequently end up with longer hospital stays than non-marijuana users, because "we don't want to discharge them on massive doses of narcotics," Wagner told Live Science. In addition, marijuana users may experience marijuana withdrawal, including symptoms of nausea and vomiting, which, in turn, could prevent them from getting proper nutrition and interfere with healing, Wagner said.

The findings may seem surprising at first, because some studies suggest that marijuana use can help with certain types of pain, such as chronic pain. But Wagner noted that the marijuana helps only if patients can take it, and because the drug is still illegal at the federal level, hospitals typically cannot allow patients to take it.

Wagner said more work is needed to figure out how to best treat trauma patients who are marijuana users, including whether a drug called dronabinol, which contains a synthetic form of tetrahydrocannabinol (THC), can help with symptoms of marijuana withdrawal, and what dose of this drug works best.

Wagner added that more awareness is needed about the potential effects of marijuana on trauma patients. "I really think a lot of people think [marijuana is] very harmless," Wagner said. "I don't think they're at all aware about … how much it's going to affect them in their recovery" from injury, Wagner said.

The study researchers noted that their findings are limited in part because the study was relatively small, and was retrospective, meaning it analyzed data that was collected previously. The researchers are planning a larger study that follows patients forward in time to further investigate the link between marijuana use and pain and opioid use in trauma patients.

Editor’s note: This story was updated on June 19 to include quotes from the study author.

Original article on Live Science.

Every day, an estimated 300 to 520 people in the U.S. try heroin, according to the Substance Abuse and Mental Health Services Administration. But how many people who try the drug end up dependent on it?

Previous studies estimated that, among those who have used heroin at least once in their lifetime, 20 to 25 percent develop a dependence on the drug.

But this rate may be higher than previously thought, according to a new study published May 30 in the journal JAMA Psychiatry. The new study found that about 30 percent of new users becomes dependent on the drug approximately one to 12 months after using it for the first time. [America's Opioid-Use Epidemic: 5 Startling Facts]

These new estimates are especially precise, according to senior study author James Anthony, a professor of epidemiology and biostatistics at Michigan State University who has been studying drug dependence for over 40 years.

Previous studies, for example, looked at heroin users from the onset of their drug use through the remainder of their lifetimes. The new study, however, assessed participants just one year after they started using heroin. This immediacy makes it less likely for subjects to die or be imprisoned during the study period, which would have taken them out of the study population, and also "determines just how quickly dependency forms," Anthony said.

"In this new study, we took into account that there are certain [heroin] users who move out of the population we study," Anthony told Live Science. "Other estimates are slightly biased, because they leave out certain users."

In the study, the researchers looked at data from 2002 to 2016 from the National Survey on Drug Use and Health (NSDUH), an annual survey on drug use and drug dependence in the U.S. Because the survey asks participants about their use of the drug only within the past year, rather than the past 30 years, it's "easier for participants to be accurate with their answers," Anthony said.

From the NSDUH data, the researchers identified more than 1,000 new heroin users and found that, overall, about 30 percent of new users developed a heroin dependence.

These rates weren't steady over the course of the study period; they've increased over the past few years. As the "purity of heroin increases," Anthony said, "[the] price of the drug decreases, and opioid use expands."

He noted, however, that the researchers weren't able to determine exactly how many times a person had to use the drug to develop a dependence on it. But it is likely more than just once: "Anybody who's dependent on heroin is a multiple-time user, and about half the time, people who [try] it never want to use again," Anthony said.

The study had several other limitations as well, he said. "People who take heroin for the first time and die right then can't be included in our study," Anthony said. The "estimates [also] rely on subjects being honest. We do our best to encourage people to be accurate, but it doesn't always work."

Still, the new study has the potential to change the way policymakers address the nation's current heroin epidemic. According to the study authors, their findings indicate that primary prevention, or stopping people before they start using heroin, and early-outreach initiatives could help control the spread of heroin use in the United States.

Originally published on Live Science.

Mussels off the coast of Seattle have tested positive for opioids.

These mussels, however, were never intended to end up on the dinner table. Instead, they were used specifically to measure levels of pollution in the waters of Puget Sound, according to a May 9 statement from the Puget Sound Institute (PSI) at the University of Washington, Tacoma.

Mussels are filter feeders; to eat, the shellfish constantly sift the water around them in their hunt for bacteria or microscopic algae. But as they filter food from the water, mussels may also absorb any chemicals and pollutants floating around them, Live Science reported in 2014.

Because of this, mussels make good barometers for pollution levels.

So, every two years, scientists at the Washington Department of Fish and Wildlife (WDFW) transplant uncontaminated mussels, raised in pristine waters, to various locations in Puget Sound, according to the statement. Then, two to three months later, the scientists analyze the mussel tissues for pollutants.

This time around, the researchers detected traces of the opioid oxycodone in mussels from three of the 18 locations tested, according to CBS News. This is the first time that opioids have been detected in Puget Sound mussels, the PSI statement said.

The opioids likely come from wastewater treatment plants, according to the statement; even filtered wastewater can contain traces of pollutants. When humans ingest opioids, traces of the drug end up in the toilet, CBS News said. Therefore, traces of opioids in the water suggest that a lot of people in the area are using the drugs, Jennifer Lanksbury, a biologist at the WDFW, told CBS Seattle affiliate KIRO 7.

Andy James, a research scientist at the PSI, noted in the statement that the levels of opioids detected in the mussels were thousands of times lower than a therapeutic dose in humans and would not be expected to affect the mussels, which don't break down the drug.

It's possible, however, that the opioids could affect fish, which are known to respond to the drugs, James added.  

The mussels tested came from highly urbanized areas, far from commercial shellfish beds where mussels are raised for food,  according to the PSI. "You wouldn’t want to collect (and eat) mussels from these urban bays," James said. 

Originally published on Live Science.

Readers of a certain age will know the reference: This is your brain. This is your brain on drugs.

The simple PSA, put out by the Partnership for a Drug-Free America in 1987, accompanied these words with an image of an egg — first intact, then sizzling on a frying pan. Gripping stuff — but what do drugs do to your brain, really?

The answer to that question depends on the drug, of course, but researchers have found that one common thread is that drugs of abuse alter the brain's so-called mesolimbic pathway, known in plain English as the reward pathway. Substances act on this pathway in different ways, said Stella Vlachou, an assistant professor of psychology at Dublin City University in Ireland, but "one way or another, different drugs of abuse would definitely affect the brain's rewards system." [10 Things You Didn't Know About the Brain]

Reward circuits

This oh-so-crucial system consists of several brain structures that communicate closely with one another via nerve impulses. At one end, deep in the midbrain, is the ventral tegmental area. At the other are the nucleus accumbens and the olfactory tubercle, both found in a region called the ventral striatum in the forebrain. The main neurotransmitter responsible for firing off signals in this pathway is dopamine, which plays an excitatory role, stimulating neurons to fire. Dopamine is a major culprit in addiction, Vlachou told Live Science, though it plays a role in normal, healthy behaviors, too.

"It is released at higher levels when we are motivated to work on something that we like, when we have a strong desire about something, when we experience something we would call reward or pleasure," she said.

Whether directly or indirectly, habit-forming substances act upon this reward system. Psychostimulants such as cocaine and amphetamines affect levels of dopamine directly, Vlachou said. In contrast, other drugs — such as opioids, nicotine and even THC (tetrahydrocannabinol), the psychoactive ingredient in marijuana — act on neurotransmitters or their receptors that indirectly affect the amount of dopamine the brain releases or detects. Some drugs, Vlachou said, have even more complex actions, perhaps interacting with the molecules that shuffle neurotransmitters across the synapses, or gaps between neurons.  

Drug by drug

There are a lot of drugs out there, especially since the advent of synthetic compounds that can mimic naturally derived substances or combine the effects of the old standards. The National Institute on Drug Abuse (NIDA) curates a long list of drugs and their effects, but here are some highlights:

Marijuana: The psychoactive ingredient in cannabis is called delta-9-tetrahydrocannabinol, better known as THC. As the name suggests, THC is a cannabinoid, and it just so happens that the body has its own cannabinoid system, known as the endocannabinoid system. Endocannabinoid receptors are found in both the brain and the immune system. In the brain, they're linked to a huge range of functions, including memory, appetite, pain sensation and sleep. They're even partially responsible for the "runner's high" that comes from intense exercise — at least in mice. As one 2013 paper in the journal Cerebrum put it, "Given the enormous complexity of the brain, the endocannabinoid system could affect behavior in an almost limitless number of ways: Simple generalizations of what will happen when CB1 receptors are globally turned on or off are not feasible." (CB1 receptors are the most prominent cannabinoid receptors in the brain.)

Thanks to the widespread nature of the endocannabinoid system, it's no surprise that THC's effects on the brain are also widespread. By interacting with cannabinoid receptors in the hippocampus and the orbitofrontal cortex — two areas of the brain associated with attention and memory — THC can create short-term memory loss and impair thinking. There are also cannabinoid receptors in the cerebellum — the structure in the back of the brain that regulates movement — which explains why someone who's high on pot may not move quickly. And yes, the cascade of THC's effects also stimulates dopamine release, making the whole experience (usually) quite pleasant. [7 Ways Marijuana May Affect the Brain]

Nicotine: Present in tobacco products and e-cigarettes, nicotine is the stuff that makes smoking so addictive. By coincidence, nicotine is very similar in structure to a neurotransmitter called acetylcholine, Vlachou said. Once in the brain, nicotine binds to acetylcholine receptors. This abundance of compounds binding to the receptors prompts the brain to release less acetylcholine, meaning the person needs nicotine to feel normal, according to the NIDA.

But nicotine affects other neurotransmitters, too. Some of the acetylcholine receptors it binds to are on cells that are responsible for releasing dopamine, so nicotine indirectly increases dopamine, tickling those mesolimbic reward pathways. It may also affect dopamine through its interactions with acetylcholine receptors that control an inhibitory neurotransmitter called gamma-aminobutyric acid and an excitatory neurotransmitter called glutamate, which, in turn, can also influence how much dopamine is released.

Opioids: Opioids include naturally derived substances, like heroin, as well as synthetic ones, like fentanyl. They're powerful short-term painkillers because they act on opioid receptors in the brain and spinal cord, which — sensing a theme? — themselves evolved to respond to compounds produced naturally inside the body, including endorphins.

When stimulated by an opioid, whether homemade or not, these receptors inhibit the nerves from sending pain signals. But opioid receptors are also found across the brain, including in the rewards pathway, where they may be involved in pleasurable sensations associated with food and sex, according to a 2009 review. Repeatedly dosing oneself with substances like heroin or prescription opioids, though, prompts the brain to stop producing as many of its own opioids. This can lead to tolerance (the need to take more opioids to get high) and dependence (horrible withdrawal symptoms that drive people to take the drug simply to feel well), according to a 2002 review in the journal Addiction Science and Clinical Practice.

What makes opioids truly deadly, though, are their actions in the brain stem, which controls breathing and other basic, automatic functions. When a person takes a high level of opioids, the molecules inhibit the neurons in the brain stem that control breathing. The result is overdose, often fatal.

Cocaine: Cocaine affects dopamine levels in the brain directly, creating an extremely pleasurable rush as the neurotransmitter floods the mesolimbic reward system. Cocaine molecules bind to a protein in the brain called a dopamine transporter, which acts like a synaptic garbageman, clearing dopamine from the gaps between neurons so that it doesn't continually stimulate the nerve cells to fire. With cocaine as a hitchhiker, the dopamine transporter can't do its job. So dopamine builds up in the synapse, and nerve cells keep firing. It's euphoric in the short term but may rob the brain of gray matter in the long term, according to 2012 research.

Psilocybin: The active ingredient in "magic mushrooms" can create quite a trippy experience, with effects ranging from the sense that time is slowing down to the feeling of being one with the universe. Research suggests that psilocybin works mostly by mimicking the neurotransmitter serotonin. Serotonin plays an important role in how the brain processes emotions, and the frontal cortex — the seat of personality and complex thought — is abundant with serotonin receptors. [Trippy Tales: The History of 8 Hallucinogens]

That means psilocybin has strong effects on complex processes — it might even alter personality permanently. The hallucinatory effect that causes people to see auras or colorful trails behind moving objects seems to be linked to the way psilocybin alters the functional connections, or communication pathways, between brain regions, according to 2014 research. The drug seems to promote the appearance of strong, long-range connections that could explain why people using it feel more connected and creative.

Originally published on Live Science.

It's difficult to describe the opioid epidemic as having anything resembling a "silver lining," but as deaths from opioid use have skyrocketed, one arguably positive outcome has been more organ donations from overdose victims, a new study suggests.

Since 2000, the number of overdose deaths in the U.S. has climbed steeply, nearly tripling in 15 years. Meanwhile, organ donations from overdose deaths have also been on the rise, increasing 24-fold during the same period. [America's Opioid-Use Epidemic: 5 Startling Facts]

More opioid-related deaths significantly increased the availability of viable organs to those who desperately needed them, according to the study, published online today (April 16) in the journal Annals of Internal Medicine. In 2017, national waiting lists for organ donations held about 120,000 names, while donors numbered slightly over 10,000; often, people in need of organ donations wait an average of five to seven years for a transplant, facing a greater chance of dying than of receiving a required organ in time, the study authors reported.

What's more, these organ donations have been successful, according to the study. The researchers noted that the outcomes from overdose victims' organ donations were as successful for transplant recipients as organ donations received from donors who died of trauma. In addition, transplant recipients often fared better with organs from overdose victims than with organs from people who died due to illnesses, the study found.

More overdose deaths, more overdose donors

In the study, researchers looked at data from 2000 to 2017 representing 138,565 organ donors and 337,934 transplant recipients. Recorded transplants included 177,522 kidneys; 97,670 livers; 35,710 hearts; and 27,032 lungs. The researchers examined the number of overdose donors over time and the success rates of donations in transplant recipients, comparing the success of organs donated by people who died from overdoses, from accidents, and from medical causes.

Five years after the surgeries were performed, transplants from overdose donors often proved as successful as donations from trauma victims and more so than donations from medical victims, the study found.

For example, the five-year survival rate for liver recipients was around 77 percent when they had overdose donors. By comparison, the survival rate was about 76 percent when the donor was a trauma victim and around 72 percent when the donor was a medical victim. [Can You Be Too Old to Donate Organs?]

One explanation for that might be that overdose victims — and many trauma victims — tend to be younger, so overall, their organs are in better shape than those of people who die of conditions such as high blood pressure, heart disease or diabetes, said lead author Dr. Christine Durand, a transplant and infectious-disease physician and an assistant professor of medicine at Johns Hopkins Medicine.

Judging the risk

Some may argue that organs from overdose victims are unsuitable for transplants, as behaviors associated with intravenous drug use usually carry a higher risk for viruses such as HIV, hepatitis B or hepatitis C, the researchers wrote in the study. However, improved screening tests are now accurate enough that health professionals can say with a high degree of certainty at the time of donation that the organ is free of infection and that the risk to recipients "is exceedingly low," Durand told Live Science.

"Screening tests have improved dramatically since the late 1990s," she said. "Testing practices include not only antibody tests for the infections, but what we call nucleic acid tests — testing for the virus in the blood — so that we would catch even donors that had been recently infected."

Though organ donations from overdose deaths are neither an ideal nor a sustainable solution to the current organ shortage in the U.S., these donations can mean the difference between life and death for people in dire need of transplants, Durand said.

"We need to maximize all of the treatments and all of the interventions to really get rid of the opioid epidemic in the U.S.," she said. "But in the face of tragedy, we also have an obligation to maximize every gift of life."

Original article on Live Science.

The same medication used to save lives by reversing opioid overdoses may also benefit nonopioid users. In a new study done in rats, the medicine, called naloxone, was shown to help the brain to recover from a stroke.

Researchers found that when male rats were treated for one week with naloxone after having an ischemic stroke, they had an improved recovery, compared with rats who did not receive naloxone. (An ischemic stroke occurs when blood flow to the brain is interrupted, usually because of a blood clot, which deprives the brain of oxygen and damages nerve cells in the area.) [Strange Stroke Stories: Ebola, Hickeys and Other Weird Causes]

Because the study was done in rats, more research is needed to confirm the findings in people. However, naloxone might play a role in stroke recovery because the drug has anti-inflammatory properties and can reduce the activity of the microglia, which are the primary immune cells of the brain, according to the study findings, published today (April 16) in the journal eNeuro.

Previous research has shown that naloxone affects the microglia, which are very active contributors to the inflammation that occurs in the brain following a stroke, said study co-author Brandon Harvey, a researcher at the National Institute on Drug Abuse in Baltimore. So, in this study, the researchers wanted to see whether giving naloxone after a stroke could decrease the activity of the brain's immune cells and reduce the associated inflammation, leading to improved recovery from the stroke, he said. 

Improved stroke recovery

In the new study, the researchers gave 65 male rats naloxone twice a day through the nose at a dose considered to be safe in humans. (Naloxone is often given as a nasal spray to reverse an overdose, according to the study.) The study showed that the drug was most effective when treatment was started within 16 to 36 hours after a stroke and lasted for seven days.

The findings showed that when naloxone was given after a stroke, during a period when immune-cell activity in the brain was peaking, it had beneficial effects on recovery, said study co-author Mikko Airavaara, principal investigator at the Institute of Biotechnology at the University of Helsinki in Finland. (Immune cells in the rats' brains were active as early as two days after a stroke and reached their peak activity seven days after a stroke, according to the findings.)

Airavaara said that naloxone works reducing inflammation in the brain and reducing the loss of nerve cells, which can improve the brain's ability to recover after a stroke.

These findings are important because there is no drug treatment now that helps the brain recover after a stroke, Airavaara told Live Science. So, developing a drug therapy that could promote recovery for the 10 million people worldwide who have strokes each year would be groundbreaking, he said.

Indeed, because naloxone has been used to treat opioid overdoses for nearly 50 years, the idea of repurposing the drug for stroke is intriguing, Harvey said.

What about people?

Still, more research is needed in animals before naloxone is studied in people who have had a stroke. [7 Things That May Raise Your Risk of Stroke]

It would be important to establish that the drug's beneficial effects would work not only in male rats but in female rats as well, Harvey told Live Science.

The current study was able to establish an effective delivery method for the drug — through the nose, which is one of the methods already used to reverse opioid overdose — and a suggested dosing pattern (when to give the drug) to possibly translate these findings into clinical practice in the future, Harvey said.

Daniel Lackland, a professor of epidemiology in the neurology department at the Medical University of South Carolina in Charleston, who was not involved in the new research, said that there is a need to identify other treatments for stroke recovery. Currently, rehabilitation includes physical-, occupational- and speech-therapy programs; however, treatments that target physiological changes in the brain are lacking, he said.

In addition, recovering from a stroke has not had the same success rates as recovering from heart disease, said Lackland, who is a spokesperson for the American Stroke Association.

This study explored the possibility that a new drug may contribute to stroke recovery, and this drug appears to have some benefits in animals, Lackland told Live Science. Though the findings need to be replicated in additional animal studies, these results give hope for the future of possible trials in humans, he said.

Originally published on Live Science.

Rates of opioid prescriptions went down in states that implemented laws allowing access to medical marijuana, according to two studies published today (April 2) in the journal JAMA Internal Medicine.

The findings suggest that access to medical marijuana may have cut patients' need for opioids to manage their pain, the researchers said.

"There has been substantive evidence that marijuana can relieve pain at a lower risk of addiction than opioids and with virtually no risk of overdose," said lead study author Hefei Wen, an assistant professor of health management and policy at the University of Kentucky College of Public Health in Lexington, Kentucky. "The potential for marijuana policies to reduce the use of addictive opioids deserves consideration, especially in states that have been hit hard by the opioid epidemic." [25 Odd Facts About Marijuana]

In one of the studies, Wen and her colleague Jason M. Hockenberry, associate professor of health policy at Emory Universtiy in Atlanta, analyzed rates of opioids prescriptions during 2011 and 2016 for Medicaid enrollees — a population that has a a relative high risk for chronic pain and opioid addiction, Wen said. They found that the rates of opioid prescribing in states that had legalized medical marijuana dropped by 5.9 percent annually, on average. What's more, states that widened access further, by legalizing the recreational use of marijuana, saw a 6.4-percent annual decrease, on average.

In the second study, another team of researchers looked at the number of opioid prescriptions filled under Medicare in all U.S. states from 2010 through 2015. Studies suggest marijuana use is rising fastest among older Americans—a group that's also most likely to have the type of pain conditions that respond best to marijuana, the researchers said. Opioid prescriptions fell by 2.21 million daily doses per year, on average, in states that legalized medical marijuana — an 8.5-percent decrease — compared with opioid prescriptions in states that didn't legalize the drug.

Marijuana vs. opioids

Studies show that cannabinoids — chemical components in Cannabis plants — can be effective in alleviating some kinds of pain, and "a mountain of anecdotal evidence from patients" suggests that some who turn to medical marijuana for chronic pain end up needing fewer opioids, said Dr. Kevin Hill, an associate professor of psychiatry at Harvard Medical School who was not involved with the studies.

"And now, with these two papers, plus a handful of previous studies, we've got pretty compelling evidence that shows that we need to really to think about cannabis as a potential way to curb the opioid crisis," said Hill, who co-authored an editorial that was published alongside the two studies in the same journal.

Opioids are a class of strong pain medications, including drugs such as OxyContin (oxycodone) and Vicodin(a combination of hydrocodone and acetaminophen). Opioids bind to opioid receptors in the body and cause feelings of euphoria. They are highly addictive, and can lead to drug abuse, severe complications and overdose deaths. The number of Americans dying from opioid overdoses continues to rise; there were more than 42,000 U.S. deaths from this cause in 2016, up from 33,000 deaths in 2015, according to a March 30 report from the Centers for Disease Control and Prevention.

Most people, including teenagers, with an opioid-use disorder start out with a legitimate prescription for the drugs from health care providers for pain management. Marijuana may be an alternative to consider for some of these patients, experts say; the cannabinoids in the drug bind to the body's cannabinoid receptors, which are part of an internal pain-relieving system.

Still, it may not be possible to replace all kinds of pain medications with marijuana. So far, clinical studies suggest that marijuana is effective in easing chronic pain, neuropathic pain (pain caused by damage to the nervous system), and involuntary and continuous muscle contractions associated with multiple sclerosis, Hill told Live Science. But to know whether marijuana is as effective for other types of pain, more research needs to be done, he added. [Could We Beat the Opioid Epidemic by Easing Pain with Marijuana?]

What's more, studying prescription data from states can only reveal a correlation between medical-marijuana laws and a reduction in opioid use; it can't show a cause-and-effect relationship, Hill said. Future studies should take a closer look at the link by performing randomized clinical trials to see the effects of taking marijuana for pain or following patients to see if marijuana helped them avoid opioids altogether or only lower their use.

Marijuana alone cannot fix the country's opioid problem. "It is but one aspect of a comprehensive package to tackle the epidemic," Wen told Live Science. Other essential strategies include providing appropriate pain management and various nonopioid and nonmedical alternatives, as well as improving access to addiction treatment, she said.

Original article on Live Science.

The number of Americans dying from opioid overdoses continues to rise, with deaths from synthetic opioids such as fentanyl doubling in just a year, according to a new report.

The report, published today (March 28) by the Centers for Disease Control and Prevention (CDC), found that in 2016, there were more than 42,000 deaths from opioid overdoses, up from 33,000 deaths in 2015. The rate of opioid overdose deaths increased by nearly 28 percent, from 10 overdose deaths per 100,000 people in 2015, to 13 overdose deaths per 100,000 people in 2016.

Much of this increase was driven by a rise in deaths from "synthetic opioids other than methadone," which includes illegally manufactured fentanyl, the report said. During the study period, deaths from synthetic opioids soared from 9,580 deaths in 2015 to more than 19,000 deaths in 2016. [America's Opioid-Use Epidemic: 5 Startling Facts]

The report also found increases in deaths related to prescription opioids, heroin, cocaine and psychostimulants (such as  methamphetamine). The researchers noted that illegally manufactured fentanyl is often mixed into counterfeit opioid pills, heroin and cocaine; so illegal fentanyl is likely contributing to deaths involving these other substances.

"No area of the United States is exempt from this epidemic," Dr. Anne Schuchat, principal deputy director of the CDC, said in a statement. "All branches of the federal government are working together to reduce the availability of illicit drugs, prevent deaths from overdoses, treat people with substance-use disorders, and prevent people from starting using drugs in the first place."

The study also specially examined opioid death rates in 31 states and in Washington, D.C.; and found that death rates from overdoses involving synthetic opioids increased in 20 states and in Washington, D.C. States with the highest death rates from synthetic opioids include New Hampshire (with a rate of 30 overdose deaths per 100,000 people), West Virginia (with 26 overdose deaths per 100,000 people) and Massachusetts (with 23 deaths per 100,000 people). Nationally, the rate of deaths from synthetic opioids was six deaths per 100,000 people.

Efforts to prevent drug overdoses will require coordination from many areas, including law enforcement, first responders, mental health providers and public health agencies, said lead author Puja Seth, of the CDC's National Center for Injury Prevention and Control.

The report highlights the need to take action to prevent these deaths, including expanding treatment for opioid-use disorders and increasing the distribution of naloxone (which can reverse the effects of an opioid overdose); improving the detection of the illegal opioid supply; and reducing exposure to prescription opioids through better prescribing practices, the researchers said.

Original article on Live Science.

Your body has its own natural pain-relief system, and scientists may be one step closer to learning how to use it. In a new study, researchers identified a part of the brain that appears to be important in controlling this system.

The researchers hope that one day, treatments that harness the power of this part of the brain could provide patients with a natural alternative to powerful pain drugs like opioids.

The new results "build a picture of why and how the brain decides to turn off pain in certain circumstances," lead study author Ben Seymour, a neuroscientist at the University of Cambridge in the United Kingdom, said in a statement. The study identifies a brain region called the pregenual cingulate cortex "as a critical 'decision center' controlling pain in the brain," Seymour said. [5 Surprising Facts About Pain]

No one likes to be in pain, but the sensation likely evolved to help us survive, the researchers said. For example, after an injury, constant pain forces us to rest, which allows the body to devote much of its energy toward healing. "Pain can actually help us recover by removing our drive to do unnecessary things — in a sense, this can be considered 'healthy pain,'" Seymour said.

But if this is true, why does the body have a natural painkilling system that turns down the pain signal in some cases, but not in others?

Seymour and his colleagues hypothesized that even "healthy pain" could be a problem if a person could actively do something to help their injury, such as finding a way to cool a burn. So the brain might activate its pain-killing system in these situations, Seymour said.

To test this hypothesis, the researchers carried out several experiments.

First, they attached metal probes to the arms of about 20 healthy participants. The probes were heated to a level that was painful, but not enough to burn the participants. Next, the volunteers played a game that involved figuring out which button on a small keypad would cool down the probe. In some cases, it was easy to turn off the probe, but in other cases, it was more difficult. During the entire task, the volunteers periodically rated their pain level, and their brain activity was monitored with the use of a brain-imaging technique called functional magnetic resonance imaging (fRMI).

The researchers found that the participants' level of pain was related to how much information they needed to learn to complete the task. When participants needed to learn which button to press to relieve their pain, their pain ratings dropped. But when the subjects knew which button to press, their pain levels were not reduced.

Using a computer model, the researchers were able to pinpoint this brain activity to the area of the brain called the pregenual cingulate cortex.

Future research should focus on understanding how this brain area might be "turned on" as a treatment for chronic pain, the researchers said.

It's important to note that this study only found an association, and didn't prove that this brain area alone is responsible for turning down participants' pain.

The study was published online today (Feb. 27) in the journal eLife.

Original article on Live Science.

The number of Americans touched by the opioid epidemic has reached alarming proportions. Millions of people are affected each year, and death rates from overdoses have quadrupled since 1999, numbering in the tens of thousands annually, according to the National Institute on Drug Abuse (NIDA). But there may be a less-risky alternative to opioids for alleviating certain types of chronic pain: marijuana.

A growing body of evidence suggests that cannabinoids — chemical components in Cannabis plants or certain synthetic compounds — can be effective in alleviating pain, either alongside or in place of opioids.

As medical marijuana becomes more accessible in the U.S., it could serve as a safer option for some kinds of pain relief and could even help to reduce the number of people addicted to opioids, experts told Live Science. [Marijuana: Facts About Cannabis]

Opioid misuse and dependency have spiked in recent years. Beginning in the late 1990s, doctors began prescribing opioids for pain relief more frequently, following false assurances by pharmaceutical companies that the drugs were not addictive, according to NIDA.

In 2016, opioid-related drug overdoses killed about 116 people every day, with 42,249 people dying from overdoses that year and some 11 million people misusing prescription opioids, according to the U.S. Department of Health and Human Services.

Generally prescribed for severe pain, opioids — a family of drugs that bind to opioid receptors in the body and cause feelings of euphoria — are, in fact, highly addictive, and millions of Americans misuse opioids or become dependent on the drugs. Opioids include opiates; though the terms are often used interchangeably, opiates can also refer to a class of opioids that are naturally or synthetically derived from opium.

If people who are addicted lose access to prescription opioids, they may turn to dangerous illegal opioids, such as heroin, Live Science previously reported. But experts say medical marijuana and synthetic cannabinoids have been found to be highly effective for certain types of pain relief and carry a much lower risk of addiction than opioids.  

"Our own opiates"

When a person uses marijuana, cannabinoids in the drug bind to cannabinoid receptors in the human body. These receptors are part of an existing pain-mitigation network that produces endocannabinoids — "our own opiates" — and primes the body to be receptive to compounds with a similar chemical makeup, Dr. Donald Abrams, a professor of medicine at the University of California, San Francisco, told Live Science.

"We have this whole system of receptors and endogenous [internal] cannabinoids that are probably present to help us modulate the sensation of pain," Abrams said. "That makes it sort of obvious that other cannabinoids — those that come from plants — could also have some benefit for pain."

THC, or tetrahydrocannabinol, is the cannabinoid in marijuana that is chiefly responsible for the drug's psychoactive effects, and cannabidiol, or CBD, is another active cannabinoid that does not cause feelings of intoxication.

Evidence from clinical studies suggests that cannabis or cannabinoids are effective in mitigating chronic pain, neuropathic pain (pain caused by a disease or injury affecting the nervous system), and involuntary and continuous muscle contractions associated with multiple sclerosis, Dr. Kevin Hill, an associate professor of psychiatry at Harvard Medical School, told Live Science in an email.

In a study published in September 2015 in the journal JAMA, Hill reviewed 74 medical studies on marijuana use for pain relief dating from 1948 to 2015. He found that there were positive results across 24 trials for patients with chronic pain, neuropathic pain and multiple sclerosis. [Marijuana: Effects of Weed on Brain and Body]

Cannabinoids are also highly effective against pain caused by symptoms associated with some cancers, researchers reported in a study published in 2016 in the journal Progress in Neuro-Psychopharmacology & Biological Psychiatry. Indeed, one type of cannabinoid, sold under the brand name Sativex, is approved in Canada for treating pain that accompanies certain cancers, according to the study.

An alternative to opioids

But how do cannabinoids stack up against opioids? 

Marijuana has been shown to produce mild dependence in people; cannabinoids affect brain processes that regulate rewards and reward-seeking behavior, much as other addictive substances, such as opioids, do, scientists reported in a study published in 2007 in the journal Dialogues in Clinical Neuroscience.

But unlike opioid dependence, marijuana dependence can generally be reversed through cognitive behavioral therapy and abstinence without debilitating withdrawal symptoms such as vomiting, diarrhea, insomnia and anxiety, according to the study.

Another side effect of opioid use can be cognitive impairment, which may discourage doctors from escalating doses enough to provide adequate pain relief, according to a study published in 2004 in the journal Pain Management Nursing. However, some cannabinoid compounds — those that do not have a psychotropic effect — can enable patients to reduce their pain without feeling "out of it," Abrams told Live Science.

"I've had patients with cancer who've been put on high doses of opiates, and they find they can't communicate with their family," Abrams said. "Once they have effectively weaned themselves off their opiates onto cannabis, they find it much easier to communicate with their loved ones, while also achieving relief of their pain." (Patients should talk to their doctor before switching drugs.) [Medical Marijuana: Benefits, Risks & State Laws]

And a survey of patients who used both opioids and cannabis for pain found that participants reported a higher satisfaction rate with cannabis than with opioides,  Amanda Reiman, a medical marijuana researcher and community relations representative for the cannabis brand Flow Kana, reported in a study published in June 2017 in the journal Cannabis and Cannabinoid Research.

In that study and in prior surveys conducted by Reiman, patients reported the same top three reasons why they turned to cannabis over prescription opioids for pain mitigation: a smaller chance of experiencing withdrawal with cannabis, fewer negative side effects, "and that cannabis was more effective than their other medication," according to Reiman, who also previously served as the California policy manager for the Drug Policy Alliance.

Of the 2,897 medical cannabis patients who served as study participants, ninety-seven percent affirmed that cannabis use enabled them to decrease their opioid doses. Furthermore, 81 percent reported that cannabis when used alone was more effective than cannabis combined with opioids, Reiman and her co-authors wrote in the study.

"Individuals that were choosing to use cannabis instead of opiates to treat pain were doing so because they were having these much better experiences," she told Live Science.

In another study, published in 2011 in the journal Clinical Pharmacology and Therapeutics, patients who were using opioids for pain relief were introduced to vaporized cannabis in clinical trials and under controlled conditions. Scientists reported that the subjects' pain was decreased significantly when they used cannabinoids, suggesting that cannabinoids could enable patients to use opioids in lower doses, and thereby experience fewer side effects.

Risks and restrictions

However, there are also risks accompanying the potential medical benefits of cannabinoid use. Some are associated with THC, which in some people can lead to increased anxiety, or worsening psychotic disorders or mood disorders, Hill said. In elderly people, disorientation from THC's effects could increase the risk of falling, Abrams added.

And cannabinoids may not be a safe choice for people with underlying cardiac disease, because the compounds can affect blood pressure and can accelerate heart rate, Abrams said.

Recent legislation reflects a changing national view of marijuana, with the drug now legally available for medical use in 29 states, the District of Columbia, Guam and Puerto Rico, and for recreational use in eight states and the District of Columbia, according to the National Conference of State Legislatures (NCSL). Possessing small amounts of the drug has also been decriminalized in 22 states and the District of Columbia, the NCSL reported.

However, one of the biggest obstacles to the more widespread use of medical marijuana for pain is the drug's accessibility, Reiman told Live Science.

In states that don't allow medical marijuana, "opiates are going to be way easier and less risky to access than cannabis," Reiman said.

Persistent stigma

Even in states where medical marijuana use is legal, persistent stigma can lead patients to hesitate to turn to cannabinoids to treat their pain, Reiman reported in the June 2017 study.

"Though we were surveying medical cannabis patients in the state of California — where there is an active program — a great deal of our respondents said that they would be more likely to use cannabis as a substitute if it were less stigmatized and more readily available," Reiman said.

Similar findings were presented in 2015 in another study, this one published in the Journal of Psychoactive Drugs, in which researchers wrote that "stigma emerged as a primary and recurring issue as it related to both the process of becoming a medical marijuana user, and remaining one."

Study participants reported that their decisions about using medical marijuana were colored by widely accepted stereotypes of all marijuana users as "stoners," and this factored into their decisions about whom they told about their medical marijuana use, according to the study.

"There was obviously that kind of negative stigma of using marijuana that I'd be looked upon as kind of an addict or a drug user more than a patient," one of the subjects responded.

The scientists also noted that when stigma is attached to a patient's medical condition, it can result in the patient receiving lesser-quality health care, and a fear of experiencing that type of discrimination may hold people back when considering the use of medical marijuana — even if they prefer it to opioids.

"There's still a lack of patient protection — the hardest thing about cannabis now is accessing it in a way that doesn't put someone at risk," Reiman said.

Original article on Live Science.

What is kratom? That depends on whom you ask. According to the U.S. Food and Drug Administration, the herbal substance falls into the category of opioids. But what exactly makes something an "opioid"?

On Tuesday (Feb. 6), FDA Commissioner Dr. Scott Gottlieb announced the results of new research suggesting that kratom compounds affect the body just like opioids do. Using a computer model, FDA researchers found that most of the compounds in kratom bind to opioid receptors in the body. Gottlieb also said that the FDA has received reports of 44 deaths involving kratom.

Kratom, also known as Mitragyna speciosa, is a plant that grows in Thailand, Malaysia, Indonesia and Papua New Guinea, according to the FDA. Herbal products containing kratom are gaining popularity in the U.S. — people are taking them to treat pain, anxiety or depression, as well as symptoms of opioid withdrawal.[America's Opioid-Use Epidemic: 5 Startling Facts]

Based on the new FDA research, along with information from previous studies and reports of harmful effects tied to kratom, "we feel confident in calling compounds found in kratom, opioids," Gottlieb said in a statement.

According to the Centers for Disease Control and Prevention, an opioid is a natural or synthetic chemical that interacts with opioid receptors in the body. Based on this definition, compounds in kratom are opioids, because they do act on opioid receptors, said Wes Hunter, the director of pharmacy at UCHealth Yampa Valley Medical Center in Steamboat Springs, Colorado.

It's true that one of the main active compounds in kratom, called mitragynine, is structurally different from morphine, one of the oldest known opioid drugs derived from the opium poppy, according to a 2012 review paper published in the Journal of Medical Toxicology. But Hunter noted that some synthetic opioids, including fentanyl and methadone, don't look much like morphine in their structure, either.

"Even though it's not a direct descendent of the opium plant, it still has direct effects on the opioid receptors," Hunter told Live Science.

Hunter added that some synthetic opioids are derived from materials found in coal tar. "It's not like you need an opium poppy to have opioid effects," he said.

However, Hunter said that the effects of opioids fall on a spectrum; for instance, both fentanyl and loperamide (sold under the brand name Imodium) are opioids, but the former is a powerful painkiller that's up to 100 times more potent than morphine, while the latter is sold over the counter as an anti-diarrheal medication. Loperamide typically doesn't cause a "high" (though people may take extremely large doses of the medication in an attempt to get high, Live Science previously reported).

Studies on kratom have found that at lower doses, the drug has a stimulant effect, while at higher doses, it has an opioid-like sedative effect, according to the Journal of Medical Toxicology paper.

Although a number of deaths have been linked to the use of kratom, it's unclear if the deaths are a direct result of using the drug, Marc Swogger, an associate professor of psychiatry at the University of Rochester Medical Center in New York, told Live Science in a 2016 interview. That's because, in many of these cases, people died after they took kratom together with other substances, such as alcohol or other opioids, according to reports of cases released by the FDA.

In the FDA statement, Gottlieb said that "cases of mixing kratom, other opioids, and other types of medication is extremely troubling." That's because "the activity of kratom at opioid receptors indicates there may be similar risks of combining kratom with certain drugs, just as there are with FDA-approved opioids," Gottlieb said.

"There is no evidence to indicate that kratom is safe or effective for any medical use," Gottlieb added. "Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids." 

In addition, because products containing kratom are not regulated by the FDA, there is a possibility that the products could be contaminated with other drugs, which together could have harmful effects, Hunter said. For example, in 2010, a product called Krypton, which contained both mitragynine and the opioid O-desmethyltramadol, was linked with nine deaths in Sweden, according to the Journal of Medical Toxicology paper.

Some people have also reported withdrawal symptoms after using kratom, the paper said. Given these effects, there is an "urgent" need to study the abuse potential of kratom, according to the paper.

For people who are seeking treatment for opioid addiction, who are thinking about using kratom, "I urge you to seek help from a health care provider," Gottlieb said. "There are safe and effective, FDA-approved medical therapies available for the treatment of opioid addiction," he said.

Original article on Live Science.

Teen use of many drugs is on the decline, but U.S. officials remain concerned about teen marijuana use — which actually increased in the past year — and vaping, which is common, according to a new survey.

The government-backed annual survey, called Monitoring the Future, gathered data from more than 43,000 U.S. students in the eighth, 10th and 12th grades.

This year's findings included a slight increase in the rate of teen marijuana use: for all three grades combined, nearly 24 percent of the students surveyed reported using marijuana in the past year, up from 22.6 percent in 2016. But rates of teen marijuana use in 2017 are about the same as they were in 2015 — meaning that overall, rates have remained stable in recent years.

Part of the reason for this year's increase in teen marijuana use may be that today's teens perceive the drug as less risky than they did a generation ago, the researchers said. In 2017, just 29 percent of high school seniors said there was a "great risk" of harm in using marijuana regularly, down from 78 percent in 1991.

"Historically, marijuana use has gone up as adolescents see less risk of harm in using it," Richard Miech, principal investigator of the survey and a professor at the University of Michigan, said in a statement. "We’ve found that the risk adolescents see in marijuana use has been steadily going down for years to the point that it is now at the lowest level we’ve seen in four decades." [7 Ways Marijuana May Affect the Brain]

Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), said marijuana use among teens is concerning, in part because of its effect on education. Teens "are in school and they are supposed to be learning," Volkow said in a news conference today (Dec. 14). But regular marijuana use has been linked with poorer educational outcomes, such as a reduced chance of graduating, according to NIDA.

The survey also found that use of electronic vaporizers, or "vaping," is popular among teens. Nearly 1 in 3 high school seniors (28 percent) said they used some kind of vaping device in the past year. And when asked what they were vaping, 52 percent said "just flavorings," 33 percent said "nicotine" and 11 percent said "marijuana" or "hash oil," the survey found. (However, some research suggests that many teens may not actually know what is in their vaping device, according to NIDA.)

For the first time, the survey also asked the teens in the study about vaping specific substances in the past month. It found that, among high school seniors, about 17 percent of the participants reported vaping of any kind in the past month, 11 percent reported vaping nicotine, 10 percent reported vaping just flavoring and 5 percent reported vaping marijuana.

"We are especially concerned because the survey shows that some of the teens using these devices are first-time nicotine users," Volkow said. "Recent research suggests that some of them could move on to regular cigarette smoking, so it is critical that we intervene with evidence-based efforts to prevent youth from using these products."

But there is good news from the survey, the researchers said. Use of illegal drugs other than marijuana and inhalants (which include sniffing glue, gases or sprays) was at its lowest level in the history of the survey, which dates back to 1975. And despite high rates of opioid use among adults, rates of opioid use among teens continue to decline.

"The reductions [in opioid use] have been quite dramatic," Volkow said. For example, in 2017, just 2 percent of high school seniors reported misusing the opioid pain reliever Vicodin in the past year, down from 10.5 percent in 2003. And rates of heroin use among teens remain low, with just 0.4 percent of high school seniors, 0.2 percent of 10th graders and 0.3 percent of eighth graders reporting use of the drug in the past year.

The survey also found:

• Rates of teen use of hookahs are declining. In 2017, 10 percent of high school seniors reported using a hookah in the past year, down from 13 percent last year and 23 percent in 2010.
• Rates of teen use of traditional cigarettes continue to decline. For all three grades combined, all measures of cigarette use (including lifetime use, past month use and daily use) are at historic lows since they were first measured in 1991. For example, just 10 percent of 12th graders reported using cigarettes in the past month, meaning that rates of cigarette use are now lower than rates of marijuana use. (About 23 percent of 12th graders said they used marijuana in the past month.)
• Rates of teen use of alcohol have been declining for many years, but in 2017, rates of alcohol use were about the same as the year before. This could herald an end to the long-term declines in teen use of alcohol, the researchers said.

Despite declines in teen use of many drugs, the researchers said that people should not be complacent about tackling teen drug use, as every new generation is vulnerable. "They don’t know about why they shouldn’t use drugs any more than they know how to read, unless we teach them again," said Lloyd Johnston, a professor at the University of Michigan and previous director of the survey, during the press conference.

Original article on Live Science.

Think about an experience that makes you feel good. It could be successfully completing a project at work, eating a warm chocolate chip cookie or taking a swig of whiskey. It could be a puff of a cigarette or a shopping trip. A dose of Vicodin or a hit of heroin.

Those experiences don't automatically lead to addiction. So what makes a particular habit or substance an addiction? What propels some people to seek out these experiences, even if they are costly or detrimental to their health and relationships?

"Addiction is a biopsychosocial disorder. It's a combination of your genetics, your neurobiology and how that interacts with psychological and social factors," said Maureen Boyle, a public health advisor and director of the science policy branch at the National Institute on Drug Abuse. That means it's a lot like any other chronic disorder, such as type 2 diabetes, cancer and heart disease. And just like other chronic diseases, addiction is both preventable and treatable, Boyle said, but added that if left untreated, it can last a lifetime. [Do Smokers' Lungs Heal After They Quit?]

The mutual mechanism

Though everyone's path to addiction is different — whether he or she tries a drug or a behavior because it's what that person's parents or peer do, or just out of curiosity — what's common across all substance and behavioral addictions is their stunning ability to increase levels of an important chemical in the brain called dopamine, Boyle told Live Science.

Dopamine is a molecule that ferries messages across the brain's reward center. It's what gives people the feeling of pleasure and reinforces behaviors critical for survival, such as eating food and having sex.

When someone uses a drug or engages in a pleasurable experience, the same natural reward circuitry is activated. "The problem with drugs is that they do the job better than natural rewards," said Dr. Hitoshi Morikawa, an associate professor of neuroscience at the University of Texas at Austin.

Different drugs tap into the dopamine reward system in different ways. Marijuana and heroin have a chemical structure similar to another neurotransmitter and can trick some brain cells into activating neurons that use dopamine. Cocaine and amphetamines, on the other hand, prolong the effect of dopamine on its target neurons, disrupting normal communication in the brain.

How quickly each drug can get into the brain, and how powerfully it activates neural circuits, determines how addictive it will be, Morikawa told Live Science. Some modes of use, like injecting or snorting a drug, make the drug's effects almost immediate. "That's why heroin, for example, is the last drug you want to take," he said. "It's very addictive."

From experimenting to getting hooked

As individuals continue with addictive habits or substances, the brain adapts. It tries to reestablish a balance between the dopamine surges and normal levels of the substance in the brain, Morikawa said. To do this, neurons begin to produce less dopamine or simply reduce the number of dopamine receptors. The result is that the individual needs to continue to use drugs, or practice a particular behavior, to bring dopamine levels back to "normal." Individuals may also need to take greater amounts of drugs to achieve a high; this is called tolerance.

Without dopamine creating feelings of pleasure in the brain, individuals also become more sensitive to negative emotions such as stress, anxiety or depression, Morikawa said. Sometimes, people with addiction may even feel physically ill, which often compels them to use drugs again to relieve these symptoms of withdrawal. [Booze Snooze: Why Does Alcohol Make You Sleepy, Then Alert?]

Eventually, the desire for the drug becomes more important than the actual pleasure it provides. And because dopamine plays a key role in learning and memory, it hardwires the need for the addictive substance or experience into the brain, along with any environmental cues associated with it — people, places, things and situations associated with past use. These memories become so entwined that even walking into a bar years later, or talking to the same friends an individual had previously binged with, may then trigger an alcoholic's cravings, Morikawa said.

Brain-imaging studies of people with addiction reveal other striking changes as well. For example, people with alcohol-, cocaine- or opioid-use disorders show a loss in neurons and impaired activity in their prefrontal cortex, according to a 2011 review of studies published in the journal Nature Reviews Neuroscience. This erodes their ability to make sound decisions and regulate their impulses.

Risk factors

Some people are more susceptible to these extreme neurobiological changes than others, and therefore more susceptible to addiction. Not everyone who tries a cigarette or gets morphine after a surgery becomes addicted to drugs. Similarly, not everyone who gambles becomes addicted to gambling. Many factors influence the development of addictions, Boyle said, from genetics, to poor social support networks, to the experience of trauma or other co-occurring mental illnesses.

One of the biggest risk factors is age. "The younger someone is, the more vulnerable they are to addiction," Boyle said. In fact, a federal study from 2014 found that the majority (74 percent) of 18- to 30-year-olds admitted to treatment programs had started using drugs at age 17 or younger.

Additionally, like most behavioral and mental health disorders, there are many genes that add to a person's level of risk or provide some protection against addiction, Boyle said. But unlike the way in which doctors can predict a person's risk of breast cancer by looking for mutations in a certain gene, nobody knows enough to be able to single out any gene or predict the likelihood of inheriting traits that could lead to addiction, she said.

Originally published on Live Science.

By now, most people are aware of the enormity of the opioid epidemic. In 2015, over 33,000 Americans died from an opioid overdose – more from opioid pain relievers than heroin.

Just because someone experiments with opioids doesn't mean that he or he will become addicted. However, there's risk with any opioid use, even when it's medically warranted. The U.S. Drug Enforcement Agency classifies opioids as a Schedule II drug, a substance with medically accepted use but a high potential for abuse.

Many parents and guardians don't think their child is at risk for misusing opioids. While that may be true, consider this: In 2013, one in eight U.S. high school seniors reported using opioids for nonmedical reasons. In 2015, 122,000 teens under 17 and 427,000 adolescents between 18 and 25 had a pain reliever use disorder, meaning that they had a problem with the drug.

I've studied substance use prevention for 15 years, including time in rehabilitation centers with teenagers addicted to heroin, so I understand how critical it is to prevent opioid use at a young age. Fortunately, there's a lot of research on this topic, as well as numerous resources to help parents figure out where to start.

What parents need to know

First, parents should educate themselves about opioids: what they are, how they work in the brain and body, risk factors for using them and how to spot signs of use.

Parents shouldn't convey misinformation about opioids to their children. If their children find out that what they've been told isn't accurate, they may turn instead to their peers for information.

There are excellent online resources available for parents and their children, such as the National Institute on Drug Abuse for Teens website and the Partnership for Drug-Free Kids' Parent Drug Guide.

It's particularly important to note the long-term effects that nonmedical use of opioids can have on adolescents. Around puberty, the brain starts a massive restructuring process. Neural connections get stronger and stronger, helping adolescents go from the emotional decision-making of youth to rational decision-making in early adulthood. This process continues until the mid- to late 20's.

During this time, what adolescents do can get "hard-wired" into the brain. So, for example, if a young person is engaged in academics, sports or learning a musical instrument, those connections get set in the brain. If they spend a lot of time using drugs, those could be the connections that stick. That means they'd have an increased chance of developing a substance use disorder later in life.

In adolescence, many people learn important life skills, including how to cope with adversity. However, long-term drug use that starts during adolescence can affect our memory and learning. Because drugs, particularly opioids, help alleviate both physical and emotional pain, adolescents may then continually turn to this drug as a way to cope, rather than using more adaptive coping skills that are usually learned during this time.

Starting the conversation

One of the most important tools that parents have is the ability to talk to their child about substance use. While talking about drugs with young people isn't always comfortable, research has shown that it's critical for prevention.

Chances are good that even young teenagers will have heard about opioids and overdose deaths at some point. Pretending that opioid use is not a problem – or thinking that a child is a "good kid" and therefore doesn't need to hear and talk about it – is a mistake. Being a "good kid" does not mean that an adolescent will not be curious or be tempted by peers.

Starting the conversation can be difficult. I advise parents to keep an eye out for a time when the topic can naturally come up. For example, if a celebrity is found to be using opioids or other drugs, or if the problem comes up in the child's school or neighborhood, or even on the child's social media account, this could provide the opening for a discussion.

Parents could ask their children if they have heard about opioids and, if so, what they know. That could be a good starting point and an opportunity to do the research together.

There are also helpful online resources that provide tips and advice on how to have these types of conversations, such as the Parent Talk Kit, which provides advice on what to say in specific scenarios with kids of different ages. For example, the beginning of high school is an incredibly important time for parents to bring up how some teens use opioids and to let their child know that, if she ever makes a mistake or gets stuck in a bad situation, she should come and talk to them.

These conversations aren't a one-shot deal. They should happen often, ideally repeating parents' expectations and adding new information when relevant.

Other tips

Parents should make an effort to get to know their children's friends. Having friends who use drugs is very strongly associated with adolescents' own drug use.

Additionally, children are less likely to use prescription drugs if their parents monitor where they are when they're not at home.

About two-thirds of teenagers who use prescription drugs for nonmedical reasons report getting the drugs from friends or family members, including taking them from medicine cabinets without people knowing. So, parents should properly and safely secure their prescription medication, especially opioids.

Finally, if parents suspect that their child is using or has a problem with opioids, it's imperative to get help as soon as possible. The best outcomes often come from intervening early.

For more information, the Partnership for Drug Free Kids has a resource hotline with advice on how to confront children about suspected drug use, as well as additional resources to help parents navigate getting children help with a substance use disorder.

The good news is that nonmedical opioid use among adolescents is on the decline. However, it's still a significant problem that needs attention. Parents have the power to help – and talking to their children is an important first step.

This story was published in collaboration with PBS NewsHour.

Margie Skeer, Associate Professor of Public Health and Community Medicine; Interim Director of the Health Communication Program, Tufts University

This article was originally published on The Conversation. Read the original article.

This article was originally published at The Conversation. The publication contributed the article to Live Science's Expert Voices: Op-Ed & Insights.

Drug overdose deaths, once rare, are now the leading cause of accidental death in the U.S., surpassing peak annual deaths caused by motor vehicle accidents, guns and HIV infection.

As a former public health official, clinician and researcher, I've been engaged in efforts to control the opioid addiction epidemic for the past 15 years.

The data show that the situation is dire and getting worse. Until opioids are prescribed more cautiously and until effective opioid addiction treatment becomes easier to access, overdose deaths will likely remain at record high levels.

How the crisis started

Opioids are drugs that stimulate the brain's opiate receptors. Some are made from opium and some are completely synthetic. In the U.S., the most commonly prescribed opioids are hydrocodone and oxycodone, which are classified as semi-synthetic because they are synthesized from opium. Heroin is also a semi-synthetic opioid. The effects of hydrocodone and oxycodone on the brain are indistinguishable from the effects produced by heroin.

Opioids are essential medicines for palliative care. They are also helpful when used for a couple of days after major surgery or a serious accident. Unfortunately, the bulk of the opioid prescriptions in the U.S. are for common conditions, like back pain.

In these cases, opioids are more likely to harm patients than help them because the risks of long-term use, such as addiction, outweigh potential benefit. Opioids have not been proven effective for daily, long-term use. Evidence suggests that chronic use of opioids can even make pain worse, a phenomenon called hyperalgesia.

Over the last two decades, as prescriptions for opioids began to soar, rates of addiction and overdose deaths increased in parallel.

The increase in opioid prescription was fueled by a multifaceted campaign underwritten by pharmaceutical companies. Doctors heard from their professional societies, their hospitals and even from state medical boards that patients were suffering needlessly because of an overblown fear of addiction.

The campaign minimized opioid risks and exaggerated the benefits of using opioids over the long term for chronic pain. Several states and counties have recently filed lawsuits against opioid manufacturers for the role they played in causing the opioid addiction epidemic by misleading the medical community.

The rise of heroin

Until 2011, most opioid overdose deaths involved prescription opioids. Then prescription opioid overdose deaths leveled off, while overdose deaths involving heroin began to soar.

Why did this happen? A common misconception is that so-called "drug abusers" suddenly switched from prescription opioids to heroin due to a federal government "crackdown" on painkillers.

There is a kernel of truth in this narrative. It's true that the vast majority of people who started using heroin after 1995 switched from prescription opioids because heroin was easier to obtain. But heroin use among young whites has been increasing since before 2011. From the beginning of the opioid crisis, young adults who became addicted to prescription opioids would switch to heroin, a less expensive option.

As young people switched to heroin, the heroin supply also became more dangerous. This caused the sharp increase in heroin overdose deaths in 2011. Increasingly, fentanyl, a potent and inexpensive synthetic opioid, was mixed with heroin or sold as heroin.

Until 2013, medical examiners didn't routinely test heroin overdose victims for the presence of fentanyl, but once they did, an alarming trend appeared. Preliminary data indicate that, in 2016, deaths involving fentanyl surpassed deaths involving prescription opioids and heroin.

Treating the crisis

There's another reason not to believe the narrative about a "crackdown" on painkillers leading to a sudden shift to heroin: There hasn't been a crackdown on prescription opioids. Despite some slowdown, the medical community continues to overprescribe opioids.

In fact, U.S. per capita opioid consumption is much higher than other developed nations. Our oxycodone consumption has started to decline, but it remains much higher than oxycodone consumption in Europe.

To bring the opioid addiction epidemic under control, the medical community must be more cautious about prescribing opioids. Federal and state governments also have to ensure that the millions of Americans now suffering from opioid addiction can access effective addiction treatment.

Buprenorphine and methadone maintenance – also known as medication-assisted treatment – are preferred treatments for opioid addiction. When patients with addiction take these medications, they are able to function and have an improved quality of life. These treatments also reduce the risk of overdose death and injection-related infectious diseases.

Buprenorphine is safer than methadone and other opioids, so it can be prescribed from a doctor's office. Methadone maintenance is administered under supervision in clinics that patients visit daily.

Unfortunately, many patients are unable to access these treatments. Despite a sharp rise in opioid addiction over the past decade, there has been only a slight increase in referrals for medication-assisted treatment in state-licensed drug treatment programs. Patients who are able to obtain treatment with buprenorphine must often visit private practice physicians who don't accept commercial insurance or Medicaid.

Until effective treatment for opioid addiction is easier to access than opioid painkillers, heroin or fentanyl, opioid overdose deaths are likely to remain at record high levels.

Andrew Kolodny, Co-Director of Opioid Policy Research, Brandeis University

This article was originally published on The Conversation. Read the original article.

In January 1889, The British Journal of Psychiatry published a letter said to have been written by a "young lady laudanum-drinker" to her doctor. The writer tells of taking laudanum, a tincture of opium, to cure her insomnia, then of her resulting torpor, desperation for more doses and (horrifying, by Victorian standards) indifference to housework. Finally, she describes quitting ("I don't like owning to bodily suffering, but will not deny that I suffered") before chastising the doctor and his colleagues for allowing this to happen.

"You doctors know all the harm those drugs do, as well as the 'victims' of them, and yet you do precious little to prevent it," she wrote.

It's a letter that could have been written about the opioid epidemic of today. Driven by a massive overprescription of opioid painkillers that is only now being reined in, the opioid epidemic claims 91 American lives each day, according to the Centers for Disease Control and Prevention (CDC). It's the deadliest drug epidemic in history, thanks to the potency and the type of drugs involved. But the epidemic today parallels the laudanum and morphine overuse outbreak of the late 1800s in many important ways, even sharing some of the same causes and racial disparities — and perhaps offering lessons on how to rein in addiction. [America's Opioid-Use Epidemic: 5 Startling Facts]

Opioids today 

Opioids are any drug that acts on the opioid receptors in the brain, spinal cord and digestive tract. Natural opioids, like morphine or heroin, come from the gum of the poppy (Papaver somniferum). There are also synthetic opioids, molecules assembled in laboratories, like the powerful drug fentanyl.

Opioids relieve pain while creating a pleasant sense of euphoria. Unfortunately, they also bind to opioid receptors in the brain stem that help coordinate breathing.

"Opioids are very dangerous because they operate on the part of your brain that tells you to breathe," said Jonathan Caulkins, a drug policy researcher at Carnegie Mellon University's Heinz College in Pittsburgh. "And if they tell you to turn off that part of your brain, you die."

The only treatment for an opioid overdose is a medication called naloxone, also known by the brand name Narcan, which blocks the binding of opioid drugs to opioid receptors in the brain stem, reversing the respiratory depression.

The deadly action and ubiquity of these drugs have created an epidemic of opioid deaths. According to the CDC, 64,070 Americans died of drug overdose in 2016. Heroin was responsible for 15,446 of those deaths, while synthetic opioids like fentanyl claimed 20,145 lives. Other natural and semisynthetic opioids killed 14,427. A recent report issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that in 2016, 11.8 million Americans misused opioids, including both street drugs like heroin and prescription drugs, such as hydromorphone (brand name Dilaudid), oxycodone (brand names OxyContin, Percocet and Percodan) and morphine.

The root of this epidemic rests in the overprescription of opioid pain medications. According to the CDC, prescriptions for opioid painkillers quadrupled in the United States between 1999 and 2014, despite no increase in reported prevalence of pain. Between 2010 and 2012, there were up to 81.2 opioid prescriptions issued per every 100 people in the United States, according to a July 2017 report in the CDC publication Mortality and Morbidity Weekly.

The problem was more severe in some states than in others. In 2012, Californians had an opioid prescription rate of less than 64 prescriptions per 100 people. That same year, Tennessee's rate was a whopping 136.1 prescriptions for every 100 people. In Alabama, there were 143.8 prescriptions per 100 people in the population.

The rate of new prescriptions has declined from its peak, to an average of 66.5 prescriptions per 100 people nationally, as of 2016. The tightening of the prescription pill supply, however, has sent some addicts into the arms of street dealers selling heroin, according to Caulkins. Prescription pills provided an on-ramp to heroin addiction for many people who would never have imagined they'd end up sticking needles in their veins, Caulkins told Live Science.

"Once you become dependent on pills, then you might do something you wouldn't do otherwise," he said.

Making matters worse, many opioid prescriptions were for chronic pain, even though research suggests that opioids aren't a very effective treatment for long-term pain. Some studies even suggest that using opioids for long periods of time can increase pain by altering the activity of glial cells in the nervous system.

The ease of swapping and trading prescription pills has also hit young people hard. In a 2017 study presented at the annual American Academy of Pediatrics conference in Chicago, doctors found that 135 individuals under age 21 test positive for opioid use or dependency in emergency rooms across the country every day. That was up from 88 youths a day in 2008, the researchers reported.

"We thought that we would probably see a handful of kids," study author Veerajalandhar Allareddy, the director of pediatric intensive care at the University of Iowa Stead Family Children's Hospital, told Live Science. "But to have these kind of numbers is very surprising."

Eighty-eight of the youth who tested positive for dependence were between ages 18 and 21, and 8 percent were between 16 and 17, Allareddy said. The vast majority, 92 percent, had no additional health conditions, indicating that they weren't using opioids as medications and were thus abusing the drugs. The late teen years are one of the most vulnerable times for falling into substance abuse, Allareddy said.

Flashbacks to laudanum

In many ways, this story has played out before. In the 1700s and 1800s in Europe and North America, the laudanum tincture became a go-to treatment for all sorts of conditions. As with chronic pain today, doctors had few other options for dealing with many patient complaints, so they prescribed laudanum for problems ranging from cough to epilepsy to insomnia to "hysteria," according to a 1979 article in the British Journal of Addiction.

Laudanum did have some real benefits: Like other opioids, it is constipating, so it was prescribed for the frequent outbreaks of diarrheal disease that haunted communities before the availability of clean, treated water. It also reduced coughing and helped relieve pain. [The 27 Oddest Medical Case Reports]

But laudanum's overuse had deadly effects. Dosing fussy infants with homespun medicines made with opium became so common in England in the 1800s that the Registrar-General Reports, which recorded annual population statistics, had to add new age categories to its "narcotic deaths" section, according to 2015 article in the Journal of Human Lactation. Between 1863 and 1867, that section recorded 236 deaths in infants younger than a year, a number that may have been underreported. Many other infants suffered. In 1816, Edinburgh physician Marshal Hall wrote about seeing a 6-month-old infant whose mother had dosed him with laudanum nightly.

"The infant is thin, emaciated, sickly, and puny, and is said to be less in bulk than on the day of its birth," Hall wrote. "He is apt to be very restless and cross, frequently cries for a long time together unappeased, and sometimes appears to be affected with griping [abdominal pain]."

Statistics on laudanum addiction in the 19th century are hard to come by. According to "Heroin: Its History, Pharmacology and Treatment" (Hazeldon, 2011), the number of opioid addicts per capita in the late 1800s was three times that of the mid-1990s in the United States, which would put the epidemic on a similar footing to today.

Some research suggests the opioid epidemic of the late 1800s had similar dynamics to the crisis of today. According to the book "Heroin," between half and two-thirds of addicts in the late 1800s were female. Today, women are also more likely to use prescription opioids than men, according to the CDC. And a report released Sept. 26 by the firm QuintilesIMS found that women between ages 40 and 59 received twice as many opioid pills after surgery than men in the same age group. This age group has the highest opioid death rate among women, according to the report. (Though men do have higher overall opioid overdose rates in general.)

Today, opioid addiction hits white Americans harder than black Americans. A 2015 analysis by the Henry J. Kaiser Family Foundation of CDC data found that 10 times more white, non-Hispanic Americans died of opioid overdose that year than either black non-Hispanic or Hispanic Americans. Research has found that black patients are less likely than white patients to be prescribed opioid painkillers for tooth, back or abdominal pain in emergency rooms. All of these conditions rely on the patient's description of the pain for a diagnosis, so the findings could indicate a subtle bias against black patients. An earlier study, published in 2008 in the journal JAMA, found disparities in emergency-room care in all types of pain, with 40 percent of white patients complaining of pain receiving an opioid prescription in 2005, compared with 32 percent for all other races. 

Diseases of despair

Likewise, the morphine and laudanum epidemic of the late 1800s was apparently more severe among white Americans than black Americans, and for similar reasons. According to a 1983 paper published in the University of North Florida's journal History Faculty Publications, the post-Civil War South saw an epidemic of morphine and other opioid abuse among whites. Black Southerners made up a tiny proportion of addicts seen in clinics in the South, wrote historian David Courtwright. The main reason, he wrote, was likely that blacks had less access to doctors than whites: They were poor, they were discriminated against, and few had the opportunity to become doctors themselves.

A possible second reason for the racial disparity also parallels today's epidemic. The post-Civil War South was a region in defeat, which had suffered high casualties in the conflict. Many people became hooked on morphine while trying to cope with war injuries, Courtwright wrote. An opium dealer in 1877 wrote that once-wealthy Southerners were turning to opium to "drown their sorrows." Newly freed black Southerners, on the other hand, had nothing to mourn.

"Confederate defeat was, for most of them, an occasion of rejoicing rather than profound depression," Courtwright wrote. 

Similarly, many experts today attribute some of the opioid epidemic to despair. The states with the highest rates of prescriptions and overdose deaths also tend to be the states where the economy is struggling and the loss of stable working-class jobs has hit hard. According to a 2015 report by Princeton researchers Anne Case and Angus Deaton, disparities in death rates between college-educated and high-school-educated middle-age white Americans tell the tale: While deaths from overdose, suicide and alcohol in this 50-to-54 age group have risen 44 percent since 1998 among men with college educations, they've skyrocketed 130 percent in white men with only a high-school education or less. For women with a college education, the death rate from these causes in middle age is up 70 percent, but for women with a high-school degree or less, they're up 381 percent. Case and Deaton call these deaths the result of "diseases of despair."

End of an epidemic

The epidemic of laudanum and morphine use in the post-Civil War era came to an end, in part, because these opium-based drugs became harder to get. In 1906, after massive public outrage surrounding a Collier's magazine series on the deceitful and harmful practices of the patent medicine industry, Congress passed the Food and Drug Act. For the first time, according to a Food and Drug Administration history, medications had to be sold according to standards of purity and strength, and ingredients like opium had to be clearly listed on the label.

From there, the supply of opium and medications made with the drug became increasingly tight. The 1914 Harrison Act required anyone selling opiates or cocaine to register with the federal government, and in 1924, heroin was made entirely illegal for the first time. The drug remained in the background, particularly in jazz and Beatnik subcultures, according to Frontline, before erupting into epidemic proportions again in the 1970s. That epidemic, Caulkins said, was again disrupted by a restriction in supply.

But there's more to the dynamics of an epidemic than how hard it is to get a drug. Caulkins and his colleagues have found that drug use spreads in a similar way that a new brand of shoes or a new style of cellphone might take hold as a trend. Early adopters try it first. In any epidemic, some proportion of these early adopters will dislike a new drug, Caulkins said. They might act as a brake on the drug's spread by telling friends to stay away, but their influence isn't as long-lasting as the influence of those who did enjoy the drug.

"When you're happy with a product, you like to tell your friends about it," Caulkins said.

But there's a natural endpoint to the spread. Over the years, as the negative effects of a drug become more obvious, people see users as an advertisement against the drug, not for it. In that sense, the widely publicized deaths from heroin or pills adulterated with fentanyl and other powerful additives could be a deterrent, Caulkins said. [10 Interesting Facts About Heroin]

"If this trend of adulterated, counterfeit pills that have fentanyl in them continues, pills may develop a bad reputation as something that's actually quite dangerous," Caulkins said.

The silver lining of opioids is that, unlike cocaine or methamphetamines, there is a medical treatment for opioid addiction. Drugs like methadone and buprenorphine can dampen cravings for opioids without causing a high, so that addicts can function on a daily basis, Caulkins said. These treatments have been shown to extend the life span of addicts and to help them hold down jobs, he said. That's "a very powerful tool" that hasn't been available for other epidemics, like the cocaine epidemic of the 1980s, he said.

However, no treatment can fully restore an opioid addict to the level of health they had before becoming addicted, Caulkins said. That's why preventing new users from starting the drugs is such a driving goal for public health officials. Part of that process is raising the alarm about the pitfalls of these drugs, just as the young laudanum-drinking woman did in the pages of The British Journal of Psychiatry 128 years ago.

"There are roughly the same number of opioid prescriptions in the U.S. as there are guns, and opioid prescriptions kill more people than guns. That includes accidents or suicides," Caulkins said. "If you or someone you know brings an opioid prescription into the house, you should think of it as bringing a gun into the house. That is the level of dangerousness."

Original article on Live Science.  

Life expectancy in the United States ticked upward between 2000 and 2015, but that rise was blunted by increasing rates of opioid-related deaths, a new report finds.

Overall, life expectancy at birth increased by 2 years between 2000 and 2015, the report found. The life expectancy for a person born in the U.S. in 2000 is 76.8 years, compared with 78.8 years for a person born in the U.S. in 2015.

Much of this increase in life expectancy can be attributed to a decrease in death rates from the leading causes of death in the country, including heart disease, cancer and stroke, according to the report, which was published today (Sept. 19) in the journal JAMA. Lower rates of death from these causes and several others contributed to a increase in life expectancy of more than 2 years, the researchers found. [America's Opioid-Use Epidemic: 5 Startling Facts]

But increasing death rates from other causes cut into this gain in life expectancy, according to the report. These causes included Alzheimer's disease, suicide, chronic liver disease, septicemia (a blood infection) and, most notably, unintentional injuries — a category that includes drug overdoses.

Drug-overdose deaths increased from about 17,400 deaths in 2000 to about 52,400 deaths in 2015, the researchers said, and the majority of these deaths were due to opioids. Drug-overdose deaths contributed to a decrease in life expectancy of 0.28 years, with opioid-related deaths accounting for 0.21 years of life expectancy lost, according to the report.

In fact, the loss of life expectancy from drug overdoses was as big as the loss of life expectancy from Alzheimer's disease, suicide, chronic liver disease and septicemia combined, according to the report. The reason the overall loss of life expectancy isn't larger, however, is that death rates from other types of unintentional deaths, such as car accidents, decreased over the course of the study period.

In addition, the researchers noted that the change in life expectancy due to opioid-overdose deaths is "likely an underestimate." This is because up to 25 percent of death certificates for drug-related deaths don't mention a specific drug, according to the report.

Between 2000 and 2014, the annual average increase in U.S. life expectancy has been 0.15 years, which is less than the annual average increase in life expectancy of 0.2 years that was recorded between 1970 and 2000, according to the report. And from 2014 to 2015, life expectancy in the U.S. decreased, the researchers said. Currently, life expectancy in the U.S. is lower than life expectancy in most other high-income countries, but preventing opioid-related deaths could help achieve larger increases in life expectancy once again, the researchers said.

To calculate life expectancy, the researchers used data from the National Vital Statistics System Mortality file, a database that contains death certificates from all 50 states and the District of Columbia. 

Originally published on Live Science.

Drug overdose deaths among U.S. teens edged upward in 2015, after declining for several years prior, according a new report.

The report, from the Centers for Disease Control and Prevention (CDC), looked at drug overdose deaths among Americans ages 15 to 19 over a 16-year period, from 1999 to 2015.

The report showed that from 1999 to the mid-2000s drug overdose deaths in this age group more than doubled, from 1.6 deaths per 100,000 people in 1999 to 4.2 deaths per 100,000 people in 2007. This increase coincided with a rise in drug overdose deaths among the U.S. population as a whole, an increase that's been partly attributed to the opioid epidemic.

However, after 2007, drug overdose deaths among teens declined, reaching 3.1 deaths per 100,000 people in 2014, the report said. (This drop was driven by a decrease in drug overdose deaths among males in this age group.)

But in 2015, the most recent year for which data is available, drug overdose deaths among teens increased again, to 3.7 deaths per 100,000 people, which is a 19 percent increase compared to 2014, the report said. In total, there were 772 drug overdose deaths in this age group in 2015. [America's Opioid-Use Epidemic: 5 Startling Facts]

This recent rise "certainly is a red flag," said Dr. Bradley Stein, a child and adolescent psychiatrist and senior physician policy researcher at the RAND Corporation, who was not involved in the report. However, Stein noted, because the overall number of drug overdose deaths among teens in this age group is relatively small, it's possible that the recent rise is just statistical "noise" rather than a true increase. In other words, more data will be needed to determine if this marks a new upward trend.

Still, "any uptick at all [in drug overdose deaths] is certainly something that has to get our attention," Stein said.

The majority of overdose deaths in this age group, 80 percent, were unintentional. However, the rate of suicides resulting from overdose was higher among females (22 percent) than males (13.5 percent), the study found.

The report analyzed the types of drugs involved in teen overdose deaths, finding that opioids had the highest death rate, followed by benzodiazepines (which are also known as "tranquilizers" and include drugs such as Valium and Xanax).

Stein noted that while people often focus on opioids as the biggest culprit in drug overdose deaths, it's often a combination of drugs that leads to overdose, and the mixture of opioids with benzodiazepines can be particularly deadly.

The study also found that there has been a spike in teen overdose deaths involving heroin and synthetic opioids (such as fentanyl) in recent years, while there has been a decrease in deaths involving semisynthetic opioids, which include prescription painkillers such as hydrocodone and oxycodone. This mirrors a trend seen in adults and suggests that while efforts to reduce prescribing of opioid painkillers may be working, they are "not a silver bullet" for solving the opioid crisis, Stein said.

Stein said it's unclear why teen drug overdose deaths decreased from 2007 to 2014 while overdose deaths increased in other age groups during this time. But Stein speculated that efforts to prevent opioid use or educate people about the risks of these drugs might have a bigger impact in teens and might prevent them from starting in the first place. More research is needed to understand which interventions work best for which demographic groups, he said.

Still, even with prevention efforts, teens may become addicted to opioids, and there is still a need to push for better opioid addiction treatments for this age group, Stein said.

The report is published today (Aug. 16) by the CDC's National Center for Health Statistics.

Original article on Live Science.

President Donald Trump has declared the opioid epidemic a "national emergency," but what happens now, and could this declaration really help address the crisis?

On Thursday (Aug. 10), Trump told reporters that the opioid epidemic is a national emergency. "We're going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis," he said.

In a statement, the White House said Trump had " instructed his administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic."

The declaration follows a recommendation from Trump's commission on the opioid crisis, which urged the president to declare a national emergency over the issue.

Experts said that the declaration was encouraging, but it's uncertain how big of an impact it will have on the opioid crisis.

"To me it's an important step, [but] there need to be many steps after this," said Dr. Bradley Stein, a psychiatrist and senior physician policy researcher at the RAND Corporation, a nonprofit research organization. Stein noted that the opioid epidemic has evolved over decades and is not something that can be solved overnight. "There's not really a silver bullet here — there's not really a single policy that's going to solve this. We as a country need to attack it at multiple fronts," Stein told Live Science. [America's Opioid-Use Epidemic: 5 Startling Facts]

Since 1999, the number of people who have died from overdoses of either prescription opioids or heroin has nearly quadrupled in the United States, according to the Centers for Disease Control and Prevention (CDC). Currently, about 1,000 Americans die per week from drug overdose (not just from opioids), according to a statement from Trump's opioid commission. And in 2015, opioids (prescription and heroin) killed more than 33,000 people, more than in any other year on record, according to the CDC.

Declaring a national emergency does bring attention to the issue, Stein said. "It certainly sends a signal about the level of federal commitment to addressing this crisis," he said.

The declaration could also open up more resources for addressing the epidemic. But exactly which resources become available will depend upon which path the administration takes for this emergency declaration.

The administration can declare an emergency in two ways: through the Stafford Act or through the Public Health Service Act, and each of these laws could help in different ways, Stein said.

A declaration through the Stafford Act would trigger the same type of aid that is available to areas after a natural disaster. This means money from the federal disaster-relief fund could be used to bolster efforts to treat opioid addiction or prevent misuse of these drugs, Stein said.

However, money from the disaster-relief fund would be limited; in total, there is currently $1.4 billion available through the fund for aiding disasters over the rest of the year. This could be enough to get some efforts started in the short term, but ultimately, a more long-term investment would be needed, Stein said.

A declaration through the Public Health Service Act could help increase access to opioid treatment in underserved areas by making it easier for doctors to practice medicine in different states, Stein said. Rather than having to go through a lengthy process to obtain a medical license in a different state, a doctor moving to an underserved area would have some of these requirements waived.

A particularly promising benefit of the "national emergency" declaration (regardless of which act is invoked) could be to allow states more flexibility in using funds from Medicaid for treating opioid disorders. For example, currently, Medicaid can't be used to reimburse treatments at psychiatric facilities, where some people with opioid disorder receive treatment, Stein said. But this barrier could be waived using either the Stafford Act or the Public Health Service Act.

"That would open up more resources [and] more facilities to be able to treat opioid disorders," Stein said.

As for next steps, Stein said there should be a focus on not only increasing access to treatment for opioid disorders, but also making sure the treatment is of high quality. In addition, more efforts are needed to reduce access to these powerful drugs, through both prescriptions and illegal markets, he said.

"Neither of those things happen[s] overnight … but we can make progress" over the long term, Stein said.

Finally, when new policies are put into place to address the opioid epidemic, it's important to revisit these policies from time to time to make sure they are working and not having unintended consequences, Stein said. For example, in recent years, the Food and Drug Administration approved newer formulations of opioids that were harder to abuse, but as a result, some people shifted to using heroin instead, Stein said.

"We can't put things in place and walk away," Stein said. "We may need to modify some of our responses" to the epidemic.

Original article on Live Science.

This article was originally published at The Conversation. The publication contributed the article to Live Science's Expert Voices: Op-Ed & Insights.

"A crippling problem." "A total epidemic." "A problem like nobody understands." These are the words President Trump used to describe the opioid epidemic ravaging the country during a White House listening session in March.

The percentage of people in the U.S. dying of drug overdoses has effectively quadrupled since 1999, and drug overdoses now rank as the leading cause of death for Americans under 50.

Drugs do exist to reverse opioid overdoses or treat long-term opioid addiction. But while opioids have become easier and easier to obtain through illicit markets and sellers on the dark web, a drug that could save countless lives has become increasingly out of reach.

Consider the addiction treatment drug, Suboxone. Patents and other exclusivities on the basic version of Suboxone expired some time ago, yet the price remains sky-high, and access problems persist. Oral film strips now cost over US$500 for a 30-day supply; even simple tablets cost a whopping $600 for a 30-day supply. The cost alone puts the medication out of reach for many.

I study the pharmaceutical industry, and I see how drug companies are able to play games that keep competition out and prices high. Lack of access to addiction treatment drugs like Suboxone can be traced, in part, to the soaring prices, access problems and anti-competitive conduct that has become business as usual in the pharmaceutical industry across the board.

Patent incentives

Pharmaceutical companies have brought tremendous advances in medicine. I believe they should be adequately compensated for the enormous amount of time and resources needed to develop a new drug. Our intellectual property system is designed to do just that, rewarding companies that bring new drugs to market with a competition-free period – 20 years from the patent application date – during which they can recoup their profits.

After this defined period, generic versions of the drug are supposed to appear on pharmacy shelves, bringing down prices to levels that can be borne more easily by consumers and the health care market generally.

Brand-name companies, however, engage in myriad games to make sure theirs is the only version of the drug on pharmacy shelves, long after generics should have joined the ranks.

Martin Shkreli, the infamous pharmaceutical industry CEO responsible for hiking the cost of his company’s lifesaving drug from $13.50 to $750 overnight, once tweeted that "Every time a drug goes generic, I grieve."

And it is not just a case of a few bad apples. Complex schemes to hold off generic competition are widespread throughout the pharmaceutical industry, as I have found in my research.

The games pharma plays, sort of like Monopoly®

Legislators on both sides of the aisle have decried sky-high drug prices, but it can be hard to pin down the specific behavior to address. Pharmaceutical game-playing has grown over the decades into a multi-headed monster, with a new tactic popping up as soon as the old one is cut off. My colleague and I set out to clearly identify and expose these various games in our book, "Drug Wars: How Big Pharma Raises Prices and Keeps Generics Off the Market."

One game we analyzed involved the filing of petitions at the Food and Drug Administration (FDA) that raise unfounded or frivolous concerns in an effort to delay generic competitors.

Some of the petitions were just stunning to us. For example, some petitions soberly ask the FDA to require, well, what it already requires, such as ensuring that the generic drug product is stable and has an appropriate shelf life. Other petitions tie the application up in knots for reasons that are hard, even for the FDA, to discuss with a straight face.

For example, the company that manufactures the blood pressure medicine Plendil filed a petition asking the FDA to delay approval of generics by citing concerns over how different types of oranges in orange juice might affect absorption of the medication and demanding additional information on the juice used in the clinical trials.

Although 80 percent of these petitions are eventually denied, it takes time and resources for the FDA to review each petition.

Citing concerns over citizen petition games, Congress recently required the FDA to respond to such petitions within five months, but a five-month delay for a blockbuster drug can be worth hundreds of millions of dollars. (The Federal Trade Commission recently filed an antitrust suit against Shire ViroPharma for attempts to hold off competition related to its gastrointestinal drug Vancocin, a campaign that included 24 filings related to a single petition.) Congress also gave the FDA the ability to summarily deny petitions when appropriate, a power that the FDA has failed to use even once.

By parsing through 12 years of FDA data, we found that out of all citizen petitions filed, the percentage of petitions with the possibility of delaying generic entry doubled since 2003, rising from 10 percent to 20 percent. Thus, in some years, one in five petitions filed at the FDA on any topic, including tobacco, food and dietary supplements, had the potential to delay generic competition.

Moreover, we found that 40 percent of such petitions were filed a year or less before the FDA approved the generic, indicating that companies are using these petitions as a last-ditch effort to hold off competition.

There are plenty of other games to play, as well. For example, generic applicants need samples of the brand-name drug to show the FDA that their version is equivalent; some brand-name companies flatly refused to sell samples to generic companies.

Another common tactic involves making tiny modifications to the dosage or formulation of a drug just as the original patents are about to expire. This strategy, known as "product hopping," allows the drug company to obtain a brand-new set of patents on their "new and improved" version of the drug.

Even if the patents are overturned – and studies show that generics convince courts to overturn the majority of patents they challenge – the process again takes time.

Much of the attention is focused on patents, but the 13 regulatory exclusivities that the FDA doles out also play help create competition-free zones. These offer months or even years of additional protection, by taking steps such as carrying out pediatric studies or developing drugs for rare diseases termed "orphan drugs." Drug companies have stretched these systems to the point at which the costs to society far outweigh the benefits.

The crippling cost of medicine

One can understand the motivation – delaying entry of a generic competitor for even a few months can translate into billions of dollars in extra revenue for the brand-name company. Thus, drug companies string out games that obstruct and delay competition, one after another. As I noted when testifying before Congress about such strategies, "A billion here, a billion there; that adds up to real money."

In 2015, 80 percent of the profit growth of the 20 largest drug companies resulted from price hikes. And drugs are vastly more expensive in the U.S. than abroad. (The liver failure drug Syprine, for example, sells for less than $400 a year in many countries; in the U.S., the average list price is US$300,000. Gilead’s hepatitis C drug, Sovaldi, reportedly sells for the equivalent of $1,000 abroad – in the U.S., it sells for $84,000.)

The industry can do this, in part, because unlike the demand for other goods, the demand for pharmaceuticals is highly inelastic. Consumers will continue to pay for the drugs that can save their lives, even if it breaks the bank.

The impact on addiction treatment

Nowhere is the pain of these games more troubling than in the market for opioid addiction medicine.

In September, I testified before a House Judiciary Subcommittee at a hearing about the state of competition in the markets for addiction medicine, noting that, while "Open and vigorous competition is the backbone of U.S. markets…we are not seeing that in the market for addiction medicine."

Pharmaceutical companies often argue that high profits are needed to fund development of new drugs, some of which don’t make it to market.

"The competitive market is structured to take maximum advantage of savings from brand competition," testified Anne McDonald Pritchett, vice president, policy and research for the Pharmaceutical Research and Manufacturers of America.

However, open and vigorous competition is certainly not what the manufacturer behind the addiction treatment drug Suboxone had in mind when it combined several games to fight off generics appearing on the horizon. These games included product hopping (shifting the market to a new form of the drug just as the exclusivity expires so pharmacists cannot fill the prescription with a generic), refusing to cooperate with generic companies on safety plans, and petitioning the FDA to impose safety measures on generic versions that were never required for the brand-name version.

The opioid addiction epidemic is a complex problem, and there are no simple answers. One thing, however, is certain. The U.S. system should not reward companies for blocking generic competition. When we do that, the American public pays the price.

Robin Feldman, Professor of Intellectual Property, University of California, Hastings

This article was originally published on The Conversation. Read the original article.

Most patients who are prescribed opioids after surgery don't take all of the prescribed pills, leaving leftover opioids that could be used inappropriately, a new review of studies finds.

Between 67 percent and 92 percent of the patients included in the review reported that, after a surgical procedure, they had unused opioids left over from a prescription. In addition, more than 70 percent of the patients in the review said they stored the leftover drugs in an unlocked location, such as a medicine cabinet, according to the review, published today (Aug. 2) in the journal JAMA Surgery.

An estimated 3.8 million Americans use opioids improperly each month, according to the 2015 National Survey on Drug Use and Health, an annual survey on drug use. And more than half of the people who misused the drugs said they got the pills from a friend or relative in at least one of the following ways: They were given the pills for free, they paid for them or they took them without asking, according to the review. [America's Opioid-Use Epidemic: 5 Startling Facts]

Surgery is often the first time a person is given a prescription for opioids, the authors, led by Dr. Mark Bicket, an assistant professor of anesthesiology and critical care at The Johns Hopkins University School of Medicine in Baltimore, wrote.

Patients who are prescribed opioids for the first time after having surgery may "inadvertently transition" into chronic users of the drugs, which include OxyContin and Vicodin, the researchers wrote. But it's also possible that patients do not use all of the opioids prescribed but do not get rid of the drugs. As a result, these pills could be taken improperly, the researchers said.

The U.S. Food and Drug Administration recommends returning leftover opioids to the pharmacy or a drug take-back program, or flushing the medication down the sink or toilet.

In the review, the researchers looked at data from six studies that included, in total, more than 800 patients. The people in the studies were prescribed opioids after having one of seven types of surgery, including cesarean sections and orthopedic surgeries, between January 2011 and December 2016.

The researchers found that a minority of patients (up to 21 percent) reported that they never filled their opioid prescription, and that another small group (7 to 14 percent of patients) reported filling the prescription but never taking the painkillers.

When patients did fill their prescription and used the opioids, many pills went unused, the researchers found: 42 to 71 percent of the pills dispensed were not taken. The main reasons people said they didn't take all of the opioid painkillers were that they weren't in pain or they were concerned about side effects. Only one of the studies in the review asked patients if they were concerned about becoming addicted to the drugs; 8 percent of the people in that study said yes.

The researchers also focused on how people stored and disposed of their opioids. Up to 77 percent, they found, kept the medicine in unlocked locations. A minority of patients (between 4 and 30 percent) planned to dispose of, or actually disposed of, the unused pills.

Safely storing opioids is important, the researchers wrote in the review. Making the drugs less accessible reduces the risk that other household members, such as adolescents, will misuse the painkillers, the researchers said.

However, the researchers noted that the review had several limitations. For example,the studies varied in how they gathered information on opioid use and not all of the studies asked the participants if they had used the drugs in the past. Including additional studies that focused on more types of surgery would strengthen the findings, they said.

Originally published on Live Science.

Too many Americans are prescribed too many opioids for too long, according to a new report from the Centers for Disease Control and Prevention (CDC).

Though the rates of doctors prescribing opioids have decreased since 2010, they still remained high in 2015 in the U.S., according to the report. In addition, the amount of opioids prescribed to Americans remained high in 2015, though that also decreased since its peak in 2010.

There were enough prescription opioids in the U.S. in 2015 "for every American to be medicated around the clock for three weeks," Dr. Anne Schuchat, acting director of the CDC, said at a news conference today (July 6). [America's Opioid-Use Epidemic: 5 Startling Facts]

"Higher opioid prescribing practices place residents … at greater risk for opioid addiction, overdose and death," Schuchat said. And the United States is currently experiencing the highest opioid overdose death rates ever recorded in the country, she added. This high death rate is driven by prescription opioids as well as illegal opioids, including heroin and illegally manufactured fentanyl, a particularly powerful form of the drug.

Schuchat said "high opioid prescribing" can be thought of in three parts.

First, too many opioid prescriptions are being written, Schuchat said. The new report found that in 2015, there were 71 opioid prescriptions written for every 100 people in the United States. This rate is down from a high of 81 prescriptions per 100 people in 2010 to 2012, according to the report.

Second, opioids are being prescribed for too many days, Schuchat said. The length of an opioid prescription has increased by about one-third, from 13 days in 2006 to nearly 18 days in 2015, the report found.

Even taking opioids for "just a few days makes a person more likely to take them long term," Schuchat said. And "taking even a low-dose opioid for more than three months increases the risk of addiction by 15 times," she said.

Third, the doses of the drugs that are prescribed are too high, Schuchat said.

To calculate the total amount of opioids prescribed to people, the CDC uses a measure called "morphine milligram equivalents" (MMEs). This measure takes into account the relative strengths of different types of opioids, using morphine as the standard. Some prescription opioids are weaker than morphine (1 milligram of codeine, for example, is equivalent to 0.15 milligrams of morphine), and others are stronger (such as 1 milligram of hydromorphone, which is equal to 4 milligrams of morphine).

Taking higher doses has been linked with an increased risk of dying from an overdose, Schuchat said. People who take a dose of 50 MMEs per day have double the risk of dying from an overdose compared with people who take a dose of 20 MMEs per day or less, Schuchat said. And a dose of 90 MMEs or more per day — which the researchers consider a "high" dose — is associated with a 10-fold greater risk of opioid overdose death compared with 20 MMEs per day. [11 Facts About Heroin]

The report found that about 7 out of 100 opioid prescriptions in 2015 were for 90 MMEs or higher a day.

Rates vary like the weather

Overall, opioid prescribing rates decreased by 18 percent from 2010 to 2015, the report found. But that decrease was limited to about half of the counties in the U.S., and every state has high-prescribing counties, Schuchat said.

There is "tremendous variation between counties," and rates vary "as much from place to place as the weather," Schuchat said. In 2015, for example, six times more opioids were dispensed in the highest-prescribing counties than in the lowest-prescribing counties, the report found.

The researchers noted that several factors were associated with counties that had high opioid prescribing rates. These included having a small city, a greater percentage of white residents, a higher concentration of primary care doctors or dentists, greater rates of people who did not have health insurance or were unemployed, and more people with diabetes, arthritis or a disability.

However, these factors explained only about one-third of the wide variation in opioid prescribing, Schuchat said.

Schuchat also noted that the CDC has released guidelines for doctors about prescribing opioids. But because these guidelines were published in 2016, the data in the new report doesn't reflect what impact, if any, they could have had on prescribing.

Researchers will be able to use the new report as a baseline with which to compare the effects of the CDC's 2016 guidelines, Schuchat said.

Originally published on Live Science.

Amid a drug crisis that kills 91 people in the U.S. each day, Attorney General Jeff Sessions has asked Congress to help roll back protections that have shielded medical marijuana dispensaries from federal prosecutors since 2014, according to a letter made public this week. Those legal controls—which bar Sessions's Justice Department from funding crackdowns on the medical cannabis programs legalized by 29 states and Washington, D.C.—jeopardize the DoJ's ability to combat the country's "historic drug epidemic" and control dangerous drug traffickers, the attorney general wrote in the letter sent to lawmakers.

The catch, however, is that this epidemic is one of addiction and overdose deaths fueled by opioids—heroin, fentanyl and prescription painkillers—not marijuana. In fact, places where the U.S. has legalized medical marijuana have lower rates of opioid overdose deaths.

A review of the scientific literature indicates marijuana is far less addictive than prescription painkillers. A 2016 survey from University of Michigan researchers, published in the The Journal of Pain, found that chronic pain suffers who used cannabis reported a 64 percent drop in opioid use as well as fewer negative side effects and a better quality of life than they experienced under opioids. In a 2014 study reported in JAMAThe Journal of the American Medical Association, the authors found that annual opioid overdose deaths were about 25 percent lower on average in states that allowed medical cannabis compared with those that did not.

Marijuana can be habit-forming, at least psychologically, but the risks are not in the same league as opioids. A 20-year epidemiological review of studies concluded that more than nine out of 10 people who try marijuana do not become dependent on the drug. The review paper, published in 2014, said the "lifetime risk of developing dependence among those who have ever used cannabis was estimated at 9 percent in the United States in the early 1990s as against 32 percent for nicotine, 23 percent for heroin, 17 percent for cocaine, 15 percent for alcohol and 11 percent for stimulants."

Also, unlike the case with opioids, it is virtually impossible to lethally overdose on marijuana—because a user would have to consume massive quantities in a prohibitively short time. The National Institute on Drug Abuse (NIDA) says such a fatal result is very unlikely. Meanwhile, heroin-related overdose deaths have more than quadrupled since 2010. The U.S. Centers for Disease Control and Prevention says that from 2014 to 2015 heroin overdose death rates increased by 20.6 percent—causing nearly 13,000 deaths in 2015.

Many heroin users in the U.S. first become addicted to legally prescribed painkillers, and turn to heroin after their pill supply dries up or becomes too expensive. According to the NIDA, nearly half of young people who inject heroin abused prescription opioids first.

And a significant number of pain sufferers would apparently prefer to use medical marijuana instead of prescription painkillers. A study published in July 2016 in Health Affairs explored what happened to Medicare (Part D) painkiller prescriptions after states green-lighted medical marijuana laws, and found that a typical physician in a state with medical cannabis prescribed 1,826 fewer painkiller doses for Medicare patients in a given year—because seniors instead turned to medical pot. There were also hundreds fewer doses prescribed for antidepressants, anti-nausea medications and antianxiety drugs.

The science on the benefits and risks of medical marijuana is far from settled, largely because conclusive research remains so difficult in spite of the drug's popularity and apparent promise. Sessions's DoJ oversees the U.S. Drug Enforcement Administration, which has long kept marijuana listed in the nation's laws as a Schedule I drug, meaning it is officially declared devoid of any currently accepted medical use and has a high potential for abuse. This federal status hobbles researchers' abilities to obtain marijuana and conduct comprehensive studies on its potential benefits, even though so many states have defied federal prohibition and the cannabis industry is booming. The DoJ did not respond to a request for comment by the time of publication.

Session's congressional letter, which was dated May 1, was obtained by Massroots.com and also confirmed and reported by The Washington Post on Tuesday. The letter urges lawmakers to remove the legal impediment that keeps his office from spending cash on interfering with state medical marijuana programs, a safeguard for dispensaries formally called the Rohrabacher–Farr Amendment. That provision expires at the end of September, and would have to be renewed to remain the law of the land—a timeline that guarantees medical marijuana will be discussed in Congress in the coming months.

W. David Bradford, a health policy expert at The University of Georgia who studies medical marijuana policies, says failing to renew the provision "would throw a lot of uncertainty into the [medical cannabis] industry and cause disruption for patients." Bradford, who was the senior author on the Health Affairs study, also links the amendment's fate to the opioid crisis: "Anything we can do to divert people away from initial opiate use," he says, "will divert them away from the potential for misuse and death."

This article was first published at ScientificAmerican.com. © ScientificAmerican.com. All rights reserved.

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Editor's Note: This story was updated at 11:20 a.m. E.T. on Tuesday June 13

A North Carolina man was arrested last month when police discovered an acre of opium poppies growing in his yard.

The alleged grower, Cody Xiong, faces a rare charge in the United States. Despite a raging opioid epidemic in the country, fields of home-grown opium are rare. The sheriff in the North Carolina case said the discovery was only the second time the plant had been found growing in the United States this year, WBTV reported.

There are two big reasons for this lack of agricultural entrepreneurship: effective U.S. law enforcement and the ease of importing heroin made from opium poppies grown elsewhere, said H. Douglas Wankel, a former assistant administrator and chief of operations in the Drug Enforcement Administration (DEA). Growing enough poppies to make heroin in the United States doesn't make much economic sense compared to importing the drug from more lawless regions, Wankel said. Compared to marijuana, opium poppies are more conspicuous and harder to process, and carry much harsher penalties for growing. [10 Interesting Facts About Heroin]

"It's very labor-intensive," Wankel told Live Science.

How heroin is made

Heroin comes from the gum of opium poppies (Papaver somniferum). These flowers aren't difficult to grow, Wankel said. They thrive in temperate climates and are probably native to the Mediterranean, but they can be grown in subtropical and tropical regions as well.

Papaver somniferum plants are the same ones that make poppy seeds, which are legal and widely available from many seed catalogues. Growing these seeds, though, puts gardeners in something of a legal gray area. The DEA includes "opium poppy" and "opium straw" (the plant, minus its seeds) on the agency's list of Schedule II drugs, meaning that technically, the DEA could press charges against anyone growing that variety in their backyard.

Practically, the agency usually doesn't do this, but in 1997, food writer Michael Pollan wrote an article for Harper's Magazine on the potential legal complications of planting opium poppies. In the article, he described the case of a counterculture writer Jim Hogshire, who was arrested for possessing a handful of dried poppy bulbs he'd bought at a florist. Felony charges against Hogshire were eventually dropped in a plea bargain that left him with a misdemeanor on his record, a $100 fine, 100 assigned hours of community service and a year of probation, The New York Times reported. Pollan found that, at the time, the DEA was quietly trying to urge garden companies not to sell Papaver somniferum seeds.

It's undeniably illegal to grow opium poppies with the intent to make opium tea, heroin or any other intoxicating substance. The processing itself is not challenging technically, though it does involve more labor than, say, harvesting marijuana: The grower must use razors to slice the bulb under the poppy plant in the morning and then wait all day for drops of thick, white opium gum to ooze out. This gum is then scraped and processed with water and solvents to extract a morphine solution. Additional chemicals are added to precipitate solid morphine out of this liquid.

This morphine solid is then dried, heated and processed with several other chemical additives to make heroin. Crude processing creates black-tar heroin, which is mostly smoked or snorted. Additional purification steps are needed to make white-powder heroin, which is injectable.

At-home heroin?

The first problem for do-it-yourself growers is that it would be hard to plant enough poppies to make an appreciable amount of drug without being noticed, Wankel said. The plants can grow more than 3 feet (0.9 meters) tall and are topped with brightly colored flowers that look a bit like frilly tulips. Any reasonably sized plot of these flowers would easily stand out in terrestrial or aerial surveys done by law enforcement agencies, Wankel said.

In one case in Oregon, a forest patrol officer stumbled across a plot of poppies in a remote area. Initially, he went to check them out because he thought the scarlet blooms would make a nice bouquet for his wife. On closer inspection, he realized the plants were suspicious.  

Though opium yields vary based on growing conditions, 2.5 acres (1 hectare) of poppies typically produce between 17.6 and 33 lbs. (8 to 15 kilograms) of raw opium, according to the book "Opium: A History" (St. Martin's Griffin, 1999). Estimated yields of heroin from raw opium are between 6 percent and 10 percent. Thus, the acre of poppies found in North Carolina would yield a little more than 13 lbs. (6 kg) of raw opium and 1.3 lbs. (0.6 kg) of heroin in a full growing season in the best of circumstances.

That's not nothing; CBS News reported in 2014 that heroin was going for $60,000 per kg (2.2 lbs.) in New York City, though actual prices vary based on purity and supply. But the value of Xiong's plants is nowhere near the $500 million that the Catawba County Sheriff's Office claimed the poppy bust was worth.

The penalties are stiff for growing poppies in the United States. According to WBTV, Xiong has been levied an illegal drug tax of $186 million for growing the plants. He has also been charged with manufacturing and trafficking by possession. North Carolina has a mandatory minimum sentence of 225 months, or almost 19 years, in prison for trafficking more than 28 grams (about 1 ounce) of heroin. (For comparison, you have to traffic more than 10,000 lbs., or 4,500 kg, of marijuana to get a mandatory minimum of 175 months, or 14 and a half years, in prison in the state.)

Given the United States' established law enforcement and stiff penalties for manufacturing heroin, most of the country's supply of the drug comes from Latin America, Wankel said. Countries in which the government is ineffective are the most fertile ground for large-scale poppy cultivation, he said.

As of 2015, the United Nations Office on Drugs and Crime (UNODC) estimated that there are more than 690,00 acres (280,000 ha) of land under cultivation for opium poppies worldwide, with approximately 330 tons (300 metric tons) of heroin produced. Afghanistan is the world capital of opium; estimates peg its share of the global opium production at between 75 and 85 percent, with an estimate of nearly 500,000 acres (200,000 ha) under cultivation as of 2016. Most of Afghanistan's production ends up on the black market in Russia, Asia and Europe, but smaller heroin producers in Myanmar and Laos also feed those markets.

Even in these countries, though, profits flow to the drug cartels that process and move heroin, not the people who grow the poppies. Vice reported in 2016 that Mexican farmers could sell a kg of opium paste for $870. The amount of heroin in that quantity of paste could, once processed, fetch more than $4,500 on the street in the United States. In Afghanistan, the UNODC estimates the total export value of the opium trade at $4 billion, only $1 billion of which goes to the farmers who grow opium poppies. The rest flows to traffickers and warlords, along with government officials who look the other way as poppy blooms nod in the fields.

Thorny problem

The problem of heroin addiction goes beyond the drug itself. Overprescription of legal opioid drugs — along with less-than-upstanding doctors and pharmacists who run "pill mills" that prescribe painkillers freely — has helped create widespread addiction to opioids, said Theodore Cicero, a professor of psychiatry at Washington University School of Medicine in St. Louis who has researched opioid abuse. (Though only 4 percent of people who misuse prescription pills go on to use heroin, nearly 80 percent of people who become addicted to heroin had used prescription pills first, according to the National Institute on Drug Abuse.)

People often turn to the drugs as a form of escape or an (extremely dangerous) do-it-yourself mental health treatment, Cicero said.

"It meets a lot of needs for people to escape medical conditions they have," he said.

As the depth of the problem has become apparent, the Centers for Disease Control and Prevention (CDC) has tightened the guidelines for prescribing opioids for chronic pain. This has taken some of the pill supply off the black market, Cicero said, but people who are addicted have turned to heroin instead.

"As you reduce the supply of prescription drugs, addicts aren't going to stop using," Cicero told Live Science. "Rather, they're going to switch to something else."

Heroin is typically much cheaper than black-market prescription drugs anyway, Cicero said. Making matters worse, opioid users gradually develop a tolerance to the drug, meaning they need more and more to get high. In the quest for customers, dealers often sell heroin mixed with even higher-octane opioids, like fentanyl. Fentanyl is 100 times more potent than morphine, according to the UNODC. According to the DEA, most black-market fentanyl in the United States is illegally manufactured, mostly in China, rather than stolen from the pharmaceutical industry.

As more potent drugs have appeared on the market, overdose deaths have spiked. Since 1999, according to the CDC, opioid overdose deaths have quadrupled. In 2015, the agency reported that 33,091 Americans died of a drug overdose involving a prescription or illegal opioid drug.

"There's a fine line between the next best jolt," Wankel said, "and the death jolt."

Editor's Note: This story was edited to note that Cody Xiong faces charges of manufcaturing and trafficking by possession, but has not yet been convicted of a crime.

Original article on Live Science. 

As heroin-related deaths soar in the United States, a group of researchers said they may be one step closer to developing a vaccine that could block the drug's addictive high.

The vaccine is the first of its kind shown to be effective in monkeys, paving the way to human clinical trials, said the researchers at The Scripps Research Institute (TSRI) who developed the treatment.

"The vaccine sequesters the psychoactive molecules that heroin produces and prevents distribution to the brain," said Paul Bremer, a graduate student at TSRI and first author of a study about the vaccine. The study was published June 2 in the Journal of the American Chemical Society. "It essentially uses your body's own natural defenses to neutralize the drug."

Heroin produces a high by activating the opioid receptors in the nervous system, triggering feelings of euphoria. The danger is that the drug can also cause the body's systems to become too relaxed, causing a slowdown in breathing. A common cause of death among people who overdose on heroin is respiratory arrest. That is, the person stops breathing and dies. [11 Facts About Heroin]

The Centers for Disease Control and Prevention (CDC) reports that heroin-related deaths in the U.S. more than quadrupled between 2010 and 2015, killing nearly 13,000 people in 2015.

The new vaccine is designed to mimic part of the heroin molecule, and train the immune system to recognize heroin as a foreign body to fend off, as it would a virus. This way, the body's own antibodies block the heroin and prevent a person who uses the drug from feeling a high.

Hopefully, this would discourage users from taking the drug again, the researchers said.

"To put it simply, vaccines have saved more lives in the last 50 years than any other therapeutic — period," said study leader Kim Janda, a chemistry professor at TSRI.

Janda's team has been working on a heroin vaccine for more than eight years and had already successfully tested the vaccine on rodents. In the most recent trial, the researchers gave three doses of heroin vaccine to four rhesus monkeysat Virginia Commonwealth University.

The trials showed the vaccine worked to suppress heroin's effects in the monkeys, the study said. What's more, two of the four monkeys who had received the vaccine for a more basic pilot study seven months earlier showed an increased resistance to heroin's high with the subsequent doses of the vaccine.

"That was promising," because other experimental vaccines that are aimed at preventing drug users from feeling high show a decrease in response over time, Bremer told Live Science. "So, we were happy to see if we keep vaccinating them a year or two years out, hopefully the response will only get greater."

Currently, drugs like methadone and buprenorphine can help opioid users fend off cravings. Another drug, naltrexone (branded as Vivitrol), given as a monthly shot, can neutralize heroin's high. But the newly tested vaccine could be less expensive and could have fewer side effects than those drug options, since it uses the body's own immune system to neutralize heroin, the researchers said. [America's Opioid-Use Epidemic: 5 Startling Facts]

However, a heroin vaccine would not be a "magic bullet" on its own against the heroin crisis, Janda stressed. He said he is not suggesting that everyone receive the vaccine to prevent addiction. Also, heroin users must first be willing to seek help and try the vaccine, he added.

A potential downside of the vaccine is that it would not help in suppressing people's cravings for a high during withdrawal, and so users might be tempted to turn to other drugs, Janda said. Use of synthetic opioids has surged in recent years, according to the CDC. One illicitly manufactured drug that might be used for that purpose is fentanyl, a painkiller that's 50 to 500 times more potent than morphine, according to the National Institute on Drug Abuse. Drug dealers often cut heroin with fentanyl, a combination that's much more lethal than heroin alone.

Janda's team has also been working on a vaccine for fentanyl and has shown that this vaccine is effective in rodents. The idea is, at some point, to combine a heroin and fentanyl vaccine into a single shot, Bremer said.

"Combination vaccines seem to work," Bremer said.

For now, the Scripps team is in talks with biotech companies to develop a human clinical trial for the heroin vaccine.

"I hope the vaccine will be useful in conjunction with other drugs," Janda told Live Science. "While there are treatments out there already, I think we need to look at other ways of fighting this problem. This could be another piece of the puzzle."

Originally published on Live Science.

The U.S. Food and Drug Administration (FDA) announced today (June 8) that it has requested that Endo Pharmaceuticals, a drug company, remove the opioid painkiller Opana ER from the drug market.

This is the first time that the federal agency has requested that a drug company voluntarily stop selling a medication because of the risk of abuse that the drug carries, the FDA said in a statement. If the company does not choose to do so voluntarily, the FDA will force the issue by withdrawing its approval for the drug.

The request was made after the FDA determined that injecting the drug, which is one way of abusing it, was linked to outbreaks of disease, including HIV and hepatitis C. [America's Opioid-Use Epidemic: 5 Startling Facts]

"The abuse and manipulation of reformulated Opana ER by injection has resulted in a serious disease outbreak," Dr. Janet Woodcock, the director of the FDA's Center for Drug Evaluation and Research, said in a statement.

In March, an advisory committee of independent experts voted 18 to eight that the benefits of the drug no longer outweighed its risks.

"When we determined that the product had dangerous and unintended consequences, we made a decision to request its withdrawal from the market," Woodcock said. "This action will protect the public from further potential for misuse and abuse of this product."

Opana ER (oxymorphone hydrochloride) was first approved by the FDA in 2006 for use by people with moderate or severe chronic pain. The extended-release formulation of the medication allowed for a continuous release of the drug into the body.

The drug was reformulated in 2012 in an attempt to make the medication more difficult for people to abuse; specifically, the drug makers sought to make it difficult for users to snort or inject the drug. Although the reformulated drug was approved, the FDA later determined that this change did not "meaningfully reduce abuse." The agency said that it would not allow the company to label the drug with language describing its potentially abuse-deterring properties, the statement said.

An FDA review of available data on the drug found that the way people abuse the medication had shifted significantly after its reformulation, changing from snorting to injection. The increase in injection of Opana ER has been linked to outbreaks of HIV and hepatitis C, two viruses that can be transmitted through syringes. There have also been cases of a serious blood disorder called thrombotic microangiogpathy linked to the abuse of the drug. 

The FDA has previously requested that companies remove opioid painkillers from the market; however, in those cases it was not because of the risk of abuse that the drug carried. In 2010, for example, the FDA recommended that drug companies stop selling the opioid pain reliever propoxyphene, but this was done because the agency determined that the drug was dangerous for heart health.

In addition, the FDA said it will continue to look at the risks versus the benefits of all other opioid painkillers on the market and take further action if needed.

"We are facing an opioid epidemic — a public health crisis, and we must take all necessary steps to reduce the scope of opioid misuse and abuse," FDA commissioner Dr. Scott Gottlieb said in the statement. "We will continue to take regulatory steps when we see situations where an opioid product's risks outweigh its benefits, not only for its intended patient population but also in regard to its potential for misuse and abuse."

Originally published on Live Science.