Help to Stop Smoking – Mayo Clinic

There are proven treatments that help people stop smoking. Medications and supportive discussion with a health care provider and counseling with a specialist will greatly increase your chances for stopping. In this video, health care providers from the Mayo Clinic describe medication and counseling options and explain how they work to help smokers stop smoking Patients tell how treatment provided for them the help they needed to become and stay smoke-free. There is effective treatment for anyone who smokes. Visit the Mayo Clinic website. www.mayoclinic.org/ndc-rst/

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Stop Smoking – Why is it so hard? – Mayo Clinic

For some people it is very hard to stop smoking. In this video experts from the Mayo Clinic explain why. The video illustrates the way in which cigarettes deliver nicotine to the brain causing changes in the brain that lead to addiction. When a person stops smoking they often experience difficult withdrawal symptoms and powerful urges to smoke. The urges and withdrawal symptoms make quitting very hard for many smokers. But hope and help for smokers can be found at the Mayo Clinic website, http://www.mayoclinic.org/ndc-rst/

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The NIH HEAL Initiative | National Institute on Drug Abuse (NIDA)

 

Request for Information on The HEALing Communities Study

NIDA, in partnership with SAMHSA, has released a Request for Information (RFI) for the HEALing Communities Study, part of NIH’s Helping to End Addiction Long-term (HEAL) Initiative. The HEALing Communities Study will test the implementation of an integrated set of addiction prevention and treatment approaches in an array of settings in up to three communities affected by the opioid crisis. Through this study, NIDA and SAMHSA aim to define effective strategies to reduce opioid overdose and overdose death, while increasing the number of individuals receiving medication-assisted treatment and the number retained in treatment and receiving needed recovery support services.  The RFI seeks input on the design, study outcomes, and necessary partnerships and infrastructure for this multi-site research effort.

NIDA is playing a major role in the National Institutes of Health (NIH) HEAL initiative (Helping to End Addiction Long-term), launched in June 2018 to provide scientific solutions to the national opioid overdose crisis, including improved treatment strategies for pain as well as opioid use disorders (OUDs).   This new initiative, funded by Congress, brings new hope for people, families, and communities affected by this devastating crisis.

NIDA will be coordinating four overarching research projects around the country:

Focused OUD Medications Development Research Project

Goal: Conduct a series of high-impact studies that will ideally lead to about 15 Investigational New Drugs (INDs), which would then produce around five New Drug Applications (NDAs) submitted to the Food and Drug Administration (FDA).

This project will focus on developing new addiction treatments and overdose-reversal tools. Three medications are currently FDA-approved to treat opioid addiction, and naloxone is available in both injectable and intranasal formulations to reverse overdose. But a wider range of options is needed in both areas. These may involve new formulations of existing drugs including longer-acting depot formulations of opioid agonists as well as stronger, longer-lasting naloxone formulations to more effectively reverse overdose from powerful synthetic opioids such as fentanyl. Research will also focus on compounds that target different receptor systems or immunotherapies to treat symptoms of withdrawal and craving in addition to the progression of opioid use disorders.

HEALing Communities Study

Goal: To determine if an integrated set of evidence-based interventions within healthcare, behavioral health, justice systems, and community organizations can work to decrease opioid overdoses and to prevent and treat opioid use disorders.

A great tragedy of the opioid crisis is that so many effective tools already exist but are not being deployed effectively in communities that need them. Only a fraction of people with opioid use disorders receive any treatment, and of those, less than half receive the medications that are universally acknowledged to be the standard of care, or they receive treatment for too short a duration. NIDA will work with the Substance Abuse and Mental Health Services Administration to launch a multisite implementation research study to identify the ideal sequence and duration of treatment within communities. Called the HEALing Communities Study, it will look at the effectiveness of a coordinated continuum of care in up to three targeted states. The studies will test the integration of prevention, overdose treatment, and medically assisted treatment in a coordinated array of settings–primary care; emergency departments; specialty care, including prenatal care, infectious disease, and behavioral health; the criminal justice system; and other community settings.

The Clinical Trials Network OUD Research Enhancement Project

Goal: Expand NIDA’s existing Clinical Trials Network to reach more communities in areas of the country hard hit by the opioids crisis.

The National Drug Abuse Treatment Clinical Trials Network (CTN) facilitates collaboration between NIDA, research scientists at universities, and treatment providers in the community with the aim of developing, testing, and implementing new addiction treatments. The network has contributed to broad reaching changes in medical practice, including the development of the opioid treatment medication buprenorphine. The CTN Opioid Research Enhancement Project will greatly expand the CTN’s capacity to conduct trials by adding new sites and new investigators. The funds will enable the expansion of existing studies and facilitate developing and implementing new studies to improve access to high-quality addiction treatment, for example, by facilitating delivery of OUD treatment in general medical settings. It will also create new opportunities for clinical and research training.

The Justice Community Opioid Innovation Network

Goal: Improve access to high-quality, evidence-based addiction treatment in justice settings.

Much research already points to the benefits of increasing access to treatment for opioid use disorders for justice-involved populations; however, it is unknown how many effective programs exist in different jurisdictions around the country, and which specific strategies are most effective. This project will create a network of researchers who can rapidly conduct studies aimed at exploring the effectiveness and adoption of medications, interventions, and technologies in those settings; and finding ways to use existing data sources as well as developing new research methods to ensure that interventions have the maximum impact. It will include implementing a national survey of addiction treatment delivery services in local and state justice systems.

Other NIH Institutes and Centers will also be involved in the NIH Heal Initiative. For example, the National Institute on Neurological Disorders and Stroke (NINDS) (see NINDS Director’s Message on the HEAL Initiative) will be funding projects to develop improved pain medications, compounds with the strength of opioids but without the risk of addiction. To see the NIH news release on the HEAL Initiative, and the full scientific research plan, go to NIH HEAL Initiative.

To see a related blog by Dr. Nora Volkow, go to An Ambitious Research Plan to Help Solve the Opioid Crisis.

To see the JAMA Viewpoint article, go to Helping to End Addiction Over the Long-term: The Research Plan for the NIH HEAL Initiative.


Planning Meeting

On June 18, 2018, the National Institutes of Health hosted the HEALing Communities Study Design Workshop to solicit feedback from scientific experts, state partners, federal partners, and other key stakeholders.  This meeting was videocast.

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Benzodiazepines and Opioids | National Institute on Drug Abuse (NIDA)

 

More than 30 percent of overdoses involving opioids also involve benzodiazepines, a type of prescription sedative commonly prescribed for anxiety or to help with insomnia. Benzodiazepines (sometimes called “benzos”) work to calm or sedate a person, by raising the level of the inhibitory neurotransmitter GABA in the brain. Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), among others.

Every day, more than 115 Americans die after overdosing on opioids.1 However, between 1996 and 2013, the number of adults who filled a benzodiazepine prescription increased by 67%, from 8.1 million to 13.5 million.2 The quantity obtained also increased from 1.1 kg to 3.6 kg lorazepam-equivalents per 100,000 adults. Combining opioids and benzodiazepines can be unsafe because both types of drug sedate users and suppress breathing—the cause of overdose fatality—in addition to impairing cognitive functions. In 2015, 23 percent of people who died of an opioid overdose also tested positive for benzodiazepines (see graph).3 Unfortunately, many people are prescribed both drugs simultaneously. In a study of over 300,000 continuously insured patients receiving opioid prescriptions between 2001 and 2013, the percentage of persons also prescribed benzodiazepines rose to 17 percent in 2013 from nine percent in 2001.4 The study showed that people concurrently using both drugs are at higher risk of visiting the emergency department or being admitted to a hospital for a drug-related emergency.

Previous studies have also highlighted the dangers of co-prescribing opioids and benzodiazepines. A cohort study in North Carolina found that the overdose death rate among patients receiving both types of medications was 10 times higher than among those only receiving opioids.5 In a study of overdose deaths in people prescribed opioids for noncancer pain in Canada, 60 percent also tested positive for benzodiazepines.6 A study among U.S. veterans with an opioid prescription found that receiving a benzodiazepine prescription was associated with increased risk of drug overdose death in a dose-response fashion.7

In 2016, the Centers for Disease Control and Prevention (CDC) issued new guidelines for the prescribing of opioids.8 They recommend that clinicians avoid prescribing benzodiazepines concurrently with opioids whenever possible. Both prescription opioids and benzodiazepines now carry FDA “black box” warnings on the label highlighting the dangers of using these drugs together. People being prescribed any medications should inform their doctors about all of the other drugs and medications they use, and patients should consult with their doctors about the potential dangers of using various medications and substances together, including the use of alcohol.

Line graph showing causes of death from opioids, benzodiazepines and opioids, and opioids without benzodiazepines between 1999 and 2015Source: Centers for Disease Control and Prevention (CDC). Multiple Cause of Death, 1999-2015.

References

  1. Centers for Disease Control and Prevention (CDC). National Vital Statistics System, Mortality. CDC WONDER Online Database. https://wonder.cdc.gov/. Published 2017. Accessed April 4, 2017.
  2. Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013. Am J Public Health. 2016;106(4):686-688. doi:10.2105/AJPH.2016.303061
  3. Centers for Disease Control and Prevention (CDC). Multiple Cause of Death, 1999-2015. CDC WONDER Online Database. https://wonder.cdc.gov/mcd-icd10.html. Accessed April 4, 2017.
  4. Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, Mackey S. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017;356:j760.
  5. Dasgupta N, Funk MJ, Proescholdbell S, Hirsch A, Ribisl KM, Marshall S. Cohort Study of the Impact of High-Dose Opioid Analgesics on Overdose Mortality. Pain Med Malden Mass. 2016;17(1):85-98. doi:10.1111/pme.12907.
  6. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011;171(7):686-691. doi:10.1001/archinternmed.2011.117.
  7. Park TW, Saitz R, Ganoczy D, Ilgen MA, Bohnert ASB. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ. 2015;350:h2698. doi:10.1136/bmj.h2698.
  8. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016;65. doi:10.15585/mmwr.rr6501e1er.

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Fentanyl and Other Synthetic Opioids Drug Overdose Deaths

 

Figure 1: Recent Trends

In 2016, synthetic opioids (primarily illegal fentanyl) passed prescription opioids as the most common drugs involved in overdose deaths in the United States.

In 2016, synthetic opioids were involved in nearly 50% (19,413) of opioid-related deaths, up from 14% (3,007) in 2010.

*This infographic summarizes mortality data from 2010-2016. Please note, 15 to 25 percent of death certificates analyzed did not indicate the type of drug involved in the overdose. This was because drug tests were not conducted or there was a failure to record test results on death certificates.

Figure 2: Synthetic Opioids Linked to Overdose Deaths with Other Substances

In 2016, 42,249 drug overdose deaths involved opioids. Of those, 45.9% involved synthetic opioids. 17,087 overdose deaths involved prescription opioids. Of those, 23.7% involved synthetic opioids. 15,469 overdose deaths heroin. Of those, 37.4% involved synthetic opioids. 10,375 overdose deaths involved cocaine. Of those, 40.3% involved synthetic opioids. 7,542 overdose deaths involved psychostimulants. Of those, 13.8% involved synthetic opioids. 10,684 overdose deaths involved benzodiazepines. Of those, 31.0% involved synthetic opioids. 4,812 overdose deaths involved antidepressants. Of those, 20.8% involved synthetic opioids. 1,877 overdose deaths involved antipsychotics and neuroleptics. Of those, 20.5% involved synthetic opioids. 409 overdose deaths involved barbiturates. Of those, 21.5% involved synthetic opioids. 543 overdose deaths involved other illicit drugs. Of those, 26.5% involved synthetic opioids.

*Deaths are not mutually exclusive. Deaths involving more than one drug or drug class are counted multiple times.

Figure 3: Type of Opioid Involved in Opioid-Related Overdose Deaths

Among the 42,249 opioid-related overdose deaths in 2016, 19,413 involved synthetic opioids, 17,087 involved prescription opioids, and 15,469 involved heroin.

*Deaths are not mutually exclusive. Deaths involving more than one drug or drug class are counted multiple times.

Figure 4: HHS Response to the Opioid Crisis

HHS is committed to:

  1. improving access to treatment and recovery services
  2. promoting use of overdose-reversing drugs
  3. strengthening our understanding of the epidemic through better public health surveillance
  4. providing supporting for cutting-edge research on pain and addiction
  5. advancing better practices for pain management

For more information about finding treatment for yourself or a loved one, visit drugabuse.gov/related-topics/treatment.

References:

Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA. 2018;319(17):1819-1821.

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