Tag Archives: opioids

Americans still consume almost all the world’s opioids

Although it comprises about 4.6% of the world’s population, the US consumes 80% of the world’s opioids. While that figure has somewhat dropped in recent years, it still remains a bane for the country and one which won’t go away in the foreseeable future.

“If you include Canada and Western Europe, [consumption of global opioid supply] increases to 95 percent, so the remaining countries only have access to about 5 percent of the opioid supply,” said Vikesh Singh, assistant professor of medicine and director of the Pancreatitis Center at Johns Hopkins University.

Popping pills

The US has a major drug problem — but it’s not the one you’re probably thinking of. It’s not weed, ecstasy, or even cocaine. In fact, it’s all about a class which most features legal drugs: opioids.

Opioids are a class of drugs that includes illegal drugs as well as powerful pain relievers available legally by prescription, such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, fentanyl, and many others. They interact with the brain’s pleasure pathways, producing pleasurable effects and relieving pain. Their potency and availability have made them popular, despite their high risk of addiction and overdose.

They have very important medical uses but, unfortunately, they’re also abused by millions — while Americans are taking more painkillers than anyone else, they’re not in more pain than others.

In 2008, an international team of researchers assessed population pain in 18 countries, finding that the prevalence of chronic pain in the United States was 43% — comparable to that of Italy (42.8%) and even lower than that in France (47.8%). You could try to argue that other countries simply don’t have as good a healthcare system as the US, but none of the statistics back that up. In fact, it’s exactly the US healthcare system that gave rise to this problem.

The opioid crisis has its roots in the 1990s, favored by the US healthcare system, in which most people are required to get their own insurance. In the absence of universal healthcare, most people prefer taking prescription pills over more expensive medications, but also more efficient therapies. In essence, you’re just trying to get the pain to go away without dealing with the cause.

Opioid usage fact sheet (data from CDC, 2013-2016)

Number of drugs ordered or provided by physicians 2.9 billion
Percent of physician visits that involve drug therapy 73.9%
People using at least one prescription drug in the past 30 days 48.4%
People using 3 or more prescription drugs in the past 30 days 24%

Some companies are taking full advantage of this, and, to an extent, even causing the problem. For instance, according to The Guardian, from 1996 to 2001, American drug giant Purdue Pharma held more than 40 national “pain management symposia” at picturesque locations, hosting thousands of American doctors, nurses and pharmacists. They also let patients try a 30-day free supply of these highly addictive drugs, acting much like the proverbial drug dealer who gives you the first shot for free. The marketing and selling of legal opioids has been an economic success for some companies, but a health disaster for Americans. When Purdue was fined over $600 million in 2007 for misleading the public, it just shrugged it off as it was already raking billions in profit.

People, however, are paying the price.

According to the U.S. Drug Enforcement Administration, “overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels.” In 2016, over 64,000 Americans died from overdoses, a 20% increase from the previous year, and a 1600% increase from 1999. There were fewer than 3,000 overdose deaths in 1970, when a heroin epidemic was raging in U.S. cities.

While opioid abusers often do end up turning to heroin, the legal opioid consumption has become a major crisis in itself.

Pills for nothing

The scale of the problem cannot be overstated. According to the HHS, drug overdose deaths are the leading cause of injury death in the United States, and the vast majority of them come from opioids.

But it wasn’t always like this. In recent years, enabled by the likes of Purdue, opioid usage is spiking across all demographics. The volume of opioid pills prescribed in the US since 1999 has quadrupled, and here’s the kicker: at a national level, the drugs don’t even help reduce pain. A recent report from the CDC found that “there has not been an overall change in the amount of pain Americans have reported in that period.”

In October 2017, US President Donald Trump declared the opioid crisis a national emergency, though the administration failed to make any major progress. Throughout his administration, the US continued to remain an unusually friendly environment for manufacturers to market opioids aggressively, while also donating generously to political causes and regulatory bodies. While this continues to be the case, there can be no real efforts to counter the opioid crisis.

Powered by an expensive and inefficient healthcare system, with insufficient government action and rapacious corporations pushing their own agenda, the future looks challenging. The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994 to 2007. The younger generations are already growing up with opioids, consumption is normalized, and the crisis seems unlikely to end anytime soon.

What is kratom: an emerging alternative to opioids

Images of a kratom plant (A) and a kratom leaf (B). Credit: U.S. Drug Enforcement Administration.

Kratom (Mitragyna Speciosa) is a tropical tree in the coffee family. Found in Southeast Asia (Thailand, Indonesia, Malaysia, and Vietnam), natives have been using Kratom medicinally for thousands of years. Those who stand by kratom claim that it can improve mood, enhance concentration, relieve pain, and increase energy.

Traditionally, kratom leaves are chewed, brewed into tea, or ground to cook with food. Nowadays, kratom is either smoked or taken orally in pill form.

Most recently, kratom is being regarded as a wonder treatment to help opioid users kick their addiction. Although there is limited evidence in the scientific literature that kratom is effective at treating withdrawal caused by heroin or prescription opioid drugs, anecdotal evidence abounds.

Kratom is typically sold as a herbal extract supplement in powdered form. The plant’s leaves can also be chewed and dry kratom can be swallowed or brewed.

However, medical professionals warn that kratom users may be trading one addiction for another. Kratom can also cause serious side effects, which is why several countries have banned kratom products.

Officially, kratom is a controlled substance in Thailand, Malaysia, Australia, and some European countries. At the moment, kratom is legal in most of the United States, but it may not be for very long. In 2016, the Drug Enforcement Administration (DEA) proposed banning kratom, a proposal that is currently pending review until more research surfaces that may provide more information about the pros and cons of kratom use.

What are the effects of kratom ?

Chemical compounds in kratom interact with receptors in the brain to trigger effects similar to both opioids and stimulants.

At low doses, kratom is a stimulant that makes users feel like they have more energy. In the United States, there are now many so-called kratom bars and cafes where people ingest the drug recreationally as if it were coffee.

However, at high doses, kratom makes you sleepy, with users reporting feeling like they are in a dream-like state.

Two chemicals in kratom leaves, mitragynine and 7-α-hydroxymitragynine, interact with opioid receptors in the brain, triggering sedation, pleasure, and decreased pain. The stimulant effect is owed to mitragynine that also interacts with other receptor systems in the brain.

Additionally, kratom has over 20 alkaloids, some of which may be involved in pain-relieving action, according to a systematic review of over 35 scientific articles published prior to 2012.

The effects of kratom kick in after 5-10 minutes and last two to five hours. They can vary wildly depending on the dose and from person to person.

What are the side effects of kratom and is it safe?

Kratom is known to frequently cause nausea and constipation, as well as muscle tremors, itching, sweating, dizziness, dry mouth, seizures, hallucinations, and even liver damage. In extreme cases, kratom may trigger seizures, coma, and death. All these side effects are quite similar to opioid withdrawal.

“The acute adverse effects of kratom experienced by many users appear to be a direct result of kratom’s stimulant and opioid activities. Stimulant effects may manifest themselves in some individuals as anxiety, irritability, and increased aggression. Opioid-like effects include sedation, nausea, constipation, and itching. Again, these effects appear to be dose-dependent and to vary markedly from one individual to another. Chronic, high-dose usage has been associated with several unusual effects. Hyperpigmentation of the cheeks, tremor, anorexia, weight loss, and psychosis have been observed in individuals with long-term addiction. Reports of serious toxic effects are rare and have usually involved the use of relatively high doses of kratom (>15 g). Of particular concern, there have been several recent reports of seizures occurring in individuals who have used high doses of kratom, either alone or in combination with other drugs, such as modafinil,” wrote researchers in a study published in The Journal of the American Osteopathic Association.

As of 2019, the FDA has reported 44 deaths associated with kratom use, although most of these fatalities also involved other drugs or used kratom that was contaminated with other substances or bacteria, such as diphenhydramine (an antihistamine), alcohol, caffeine, benzodiazepines, fentanyl, and cocaine. At least one case investigated by the FDA seems to be associated with the use of pure kratom.

Between 2011 and 2017, poison control centers in the U.S. received around 1,800 calls involving kratom, some of which resulted in death. A 2019 analysis by the FDA of 30 different kratom products sold online found traces of heavy metals in some, including lead and nickel in toxic doses. “Based on these test results, the typical long-term kratom user could potentially develop heavy metal poisoning, which could include nervous system or kidney damage, anemia, high blood pressure, and/or increased risk of certain cancers,” according to the FDA report.

“We have issued numerous warnings about the serious risks associated with the use of kratom, including warnings about the contamination of kratom products with high rates of salmonella that put people using kratom products at risk, and resulted in numerous illnesses and recalls,” acting FDA Commissioner Dr. Ned Sharpless said in a statement. “Despite our warnings, companies continue to sell this dangerous product and make deceptive medical claims that are not backed by science or any reliable scientific evidence.”

Is kratom addictive?

Images of kratom products purchased at a “smoke shop” in suburban Chicago. The images show chopped leaves (A), which are typically brewed into “kratom tea”, capsules containing finely chopped leaves (B), and compressed tablets containing leaves or resin (C).

Although many turn to the drug in order to beat their opioid addiction, kratom can cause an addiction in its own right. Common withdrawal symptoms include pain, trouble sleeping, diarrhea, mood disorders, and fever.

Since kratom is still poorly studied, there is no specific medical treatment for kratom addiction.

Although many people use kratom to control withdrawal symptoms caused by opioid addiction or other addictive drugs like alcohol, there is no scientific evidence that kratom is actually effective for this purpose.

However, a survey of more than 2,700 self-reported users of the herbal supplement performed by Johns Hopkins concluded that “the psychoactive compound somewhat similar to opioids likely has a lower rate of harm than prescription opioids for treating pain, anxiety, depression and addiction.”

According to the survey, about 41% of survey responders said they took kratom to treat opioid withdrawal, and of those people who took it for opioid withdrawal, 35% reported going more than a year without taking prescription opioids or heroin.

“These findings suggest that kratom doesn’t belong in the category of a Schedule I drug, because there seems to be relatively low rate of abuse potential, and there may be medical applications to explore, including as a possible treatment for pain and opioid use disorder,” said Albert Garcia-Romeu, instructor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

“There has been a bit of fearmongering,” he adds, “because kratom is opioidlike, and because of the toll of our current opioid epidemic.”

Is kratom legal?

In most of the United States, kratom is for the time being still legal. The Food and Drug Administration (FDA) has not approved kratom and actually voiced concerns over its use, but since it is marketed as a supplement it can be sold legally.

On August 31, 2016, the DEA published a notice that it was planning to place kratom in Schedule I, the most restrictive classification of the Controlled Substances Act. The scheduling did not occur, however, after dozens of members of Congress, as well as kratom advocates, argued that kratom’s potential medical benefits deserve more time for deliberation.

It is, however, illegal to purchase, possess, or use kratom in Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin. Other states and municipalities have classed kratom as “illegal for human consumption,” which is why you’ll find it listed as incense.

Elsewhere, kratom is classed as illegal in Israel, Japan, Thailand, Myanmar, Malaysia, Singapore, South Korea, Australia, New Zealand, Vietnam, and most European countries. This list by no means complete and every country might change how they control the use and distribution of the herbal supplement.

Kratom is easily orderable on the internet and is often sold as a green powder labeled “not for human consumption”.

Bottom line: Many users stand by the therapeutic effects of kratom with almost zealous fever. However, there are many safety concerns surrounding kratom, among them its potential for addiction and the risk of contamination with other potentially toxic substances. Kratom may have medical properties but the evidence so far is still limited, warranting further research. The FDA is rather clear about it: there is no scientific evidence that supports the use of kratom for medical purposes, nor should it be used as an alternative to prescription opioids. What’s more, kratom is not regulated so you have no guarantee that what you buy online doesn’t contain potentially toxic substances.

Although kratom is derived from a plant, consumers should not be fooled by the myth that anything natural is 100% safe. Many drugs with dangerous side effects are botanical in nature, including heroin, cocaine, and nicotine.

The United States’ opioid crisis cost $2.5 trillion over four years

The growing misuse of prescription drugs is not only reflected by an increasing number of deaths but also nationwide economic destruction. According to the White House’s Council of Economic Advisers (CEA), the opioid crisis cost $696 billion in 2018 — a staggering 3.4% of the United States’ GDP. Since 2015, more than $2.5 trillion have been lost due to the opioid crisis.

CEA’s estimate is based on a number of factors, including the value of lost lives, as well as healthcare and substance abuse treatment costs, criminal justice costs, and reductions in productivity.

In 2017, there were a record 70,000 drug overdose deaths, about two-thirds of which were linked to opioids. The toll was so high that the Centers for Disease Control and Prevention linked it to a rare drop in US life expectancy that year.

Prescription painkillers are no longer the leading cause of overdose deaths. In the past decade, heroin — which now kills four times more people than in 2000 — and then fentanyl, surpassed prescription opioid drugs as the main cause of overdose death.

Credit: CDC Wonder database.

Previously, the Society of Actuaries, another healthcare research organization, found that the economic burden of opioids from 2015 through 2018 was $631 billion.

However, the CEA argues that other studies fail to account for the most important economic loss — fatalities due to drug overdose and the lost economic gains that could have been achieved throughout those lifetimes.

That’s not to say that one report is better than the other. The White House report estimated the total societal welfare cost associated with opioid addiction, whereas the Society of Actuaries looked at the direct estimate of the return you would see if the epidemic was reversed.

Regardless of who’s right or wrong, what’s certain is that both figures are extremely high. Even if only the healthcare and substance abuse treatment costs associated with prescription opioid misuse are taken into account, it amounts to a nonfatal cost of at least $58 billion. According to the CEA report, there were 1.9 million individuals with a prescription opioid disorder, resulting in an average cost of approximately $30,000.

Investing in curbing the opioid epidemic could thereby lead to a significant return on investment.

Sen. Elizabeth Warren (D-MA) proposed in May the allocation of $100 billion over 10 years to fight the opioid crisis. Warren compares the initiative to the Ryan White CARE Act, which dedicated billions of dollars to boost the government’s response against the HIV/AIDS epidemic. At the time HIV/AIDS had been rising fast across the country (ever since the 1980s), but a few years after the initiative was passed the crisis finally reached a turning point and the death toll started to decrease.

In 2018, Congress added $3.3 billion to address the opioid health crisis on top of the $500 million it had approved in the 21st Century Cures Act. Although this increase is welcome, many believe it was inadequate given the scale of the drug epidemic.

There are some reasons to be optimistic about the future. In 2018 there were fewer overdose fatalities than in 2017, a 5% decline that marks the first drop in three decades.

Credit: Recovery Bootcamp.

Fentanyl is now the deadliest drug in America

Credit: Recovery Bootcamp.

Credit: Recovery Bootcamp.

An opioid that’s several times stronger than heroin is now officially the deadliest drug in the United States, say researchers at the Centers for Disease Control and Prevention (CDC). The same report shows that drug overdoses climbed again last year, contributing to a growing drug epidemic in the country that shows no sign of slowing down in the near future.

Fentanyl is a very powerful synthetic opioid that’s 50 to 100 times more concentrated than morphine. For a user with little tolerance to the drug, even less than a milligram of fentanyl can trigger an overdose. Imagine a few grains of sand — that’s enough to kill you if it’s fentanyl. This makes it incredibly easy for people to overestimate their dosage, getting themselves killed in the process. In most cases, however, people are not aware that they are taking fentanyl as the drug is often cut into other substances to make them stronger.

“It’s very difficult for people to know just how much they are extracting from the patch and injecting. It is already a very powerful opioid and people are injecting it without being able to control how much,” said NDARC’s Director Michael Farrell.

“Like all opioids including heroin, fentanyl is a respiratory depressant – it interferes with the user’s ability to breathe. Because it is so concentrated people can misjudge the dose for themselves to dangerous degree.”

In 2015, more than 52,000 people died of drug overdoses. In 2016, the total rose to more than 63,000 — a jump that was largely driven by fentanyl. According to the latest CDC report on drug use, fentanyl was involved in nearly 29% of those cases, while heroin came in second with 25% and methamphetamine was third at a rate of over 10%. What’s staggering is that in 2011, fentanyl was responsible for only 4% of overdoses. Between 2013 and 2016, overdoses from fentanyl rose 113% a year.

Credit: CDC.

Credit: CDC.

The drug has been around for decades in the form of medicine meant to relieve pain. The main reason why it’s become so popular can be traced down to the rise in opioid painkillers that have been sweeping the nation. As people looked for stronger, cheaper alternatives, fentanyl naturally became popular. This is a drug that’s relatively easy to produce, which provides a cheaper high per dose than heroin.

And as if fentanyl wasn’t scary enough, an analog called carfentanil is also creeping up in the illicit drug market. Carfentanil is normally used as a sedative for large animals such as elephants and can be very dangerous if it enters the body of humans. It’s so dangerous that some countries, the U.S. included, have described it as a ‘chemical weapon’ and have prepared contingency plans in the face of its potential use in war.  

Law enforcement officials believe that most of this fentanyl comes from labs in China, from where it is shipped to South America before making its way to US markets. One of the things that make these drugs so deadly is the fact that very often drug users don’t seek them out, instead buying heroin that turns out to be laced with potent fentanyl or one of its analogs. A user might take a hit of their usual dose, only to end up overdosing because of the added fentanyl. Of course, many times users deliberately take these drugs. Prince, for example, overdosed on fentanyl he was taking as medication.

There’s no clear-cut solution to the rise of fentanyl or synthetic opioids in general. Even cracking down on the supply is not a particularly good solution. If opioid painkiller would magically disappear overnight, people would turn to heroin. If there was no heroin, they’d go for fentanyl, and then to carfentanil, and then to the hundreds of other analogs. Perhaps a solution to the crisis involves tackling demand, not supply, through extensive drug prevention and treatment measures.  

Dog and owner.

FDA says seriously, stop stealing your pets’ opioids

Veterinarians, beware — the Food and Drug Administration (FDA) wants you to keep an eye out for owners taking opioids prescribed to their pets.

Dog and owner.

Image via Pixabay.

The US opioid crisis has been frequently making headlines in recent years, and for good reason: mortality rates associated with opioid abuse are at an alarming high and continue to climb. The half-century-long War on Drugs, despite draining over a trillion dollars, doesn’t seem capable of curbing these deaths.

Over-prescription of opioid medication, caused by misleading advice offered by pharmaceutical companies, has taken most of the blame for the crisis. Government health services responded by issuing a five-point strategy for ‘front line’ members of the medical community, providing support for addiction treatment, advising alternatives to opioids, and promoting research partnerships.

However, the FDA fears it left the back door unwatched. Despite their efforts to mediate legal access to opioid medication, overdose-induced tragedy still takes place; the agency believes that pet prescriptions may be part of the reason why.

Pet addiction

An online statement published last week by the FDA draws attention to a rarely considered access point for illicit opioid medications. FDA Commissioner Scott Gottlieb reminded veterinarians that some pet owners are taking the opioids prescribed for their companions.

“One such important care group is veterinarians who may prescribe them to manage pain in animals,” he says. “That’s why we have developed a new resource containing information and recommendations specifically for veterinarians who stock and administer opioids.”

Gottlieb admits that veterinarians have been left out in the cold on this one. Very little effort has been made to inform them of the risks posed by prescriptions for pets. He also recognizes the role opioids and associated pain medications play in treating both animal and human patients — so they won’t be going anywhere soon.

“But just like the opioid medications used in humans, these drugs have potentially serious risks, not just for the animal patients, but also because of their potential to lead to addiction, abuse and overdose in humans who may divert them for their own use,” Gottlieb adds.

The FDA’s new resource, titled The Opioid Epidemic: What Veterinarians Need to Know, reminds practitioners to follow state and federal regulations when prescribing opioid medication, seek alternatives where possible, educate pet owners, and be vigilant of signs of abuse.

While this is the largest single measure the FDA has taken to combat opioid abuse sourced from veterinarians, it’s not the first such measure in the US. Last year, Maine and Colorado passed legislation requiring veterinarians to check the prescription history of a pet’s owner before prescribing opioids for the animal. Alaska, Connecticut, and Virginia instead chose to set strict prescription limits.

The FDA further hopes that their resource will help put the worries of vets at ease. Speaking to the Washington Post on the topic last year, Kevin Lazarcheff, president of the California Veterinary Medical Association, said that he’s a “veterinarian, not a physician,” so he “shouldn’t have access to a human’s medical history.” The new recommendations don’t require the vets to dig into an owner’s medical history.

“We know that licensed veterinarians share our concerns and are committed to doing their part to ensure the appropriate use of prescription opioids,” says Gottlieb.

“We hope the resources we’re providing today, coupled with the existing guidelines from AVMA, will assist the veterinary medical community about steps they can take when prescription opioids are part of their care plan for their animal patients.”

Unwise opioids for wisdom teeth

There’s wisdom in toughing through the pain — people who use opioids for wisdom tooth removal are almost three times more likely to develop an opioid addiction.

Dental panoramic x-ray. Wisdom teeth are in orange. Image courtesy: IHPI.

Wisdom teeth are one of the three molars in human dentition — the most posterior of the three. They tend to erupt between the ages of 17 and 25, though that’s not always the case.  Most adults have four wisdom teeth, one in each quadrant of the mouth, but it’s possible to have more, fewer, and even none. It’s not exactly clear why this happens, but what is clear is that once they do erupt, they tend to cause a lot of pain.

Getting rid of your wisdom teeth was once regarded as a rite of passage — you would shed them during your teen years, symbolizing that you are becoming an adult, and therefore (allegedly) wiser. For most people, wisdom teeth are a pain and a half. It’s not surprising that many choose to address the teeth-induced pain with opioids. But that, researchers say, might be a very unwise decision.

These opioid painkiller prescriptions might be setting young Americans on a path to opioid addiction, a new study has shown. Young people aged 13 to 30 who filed an opioid prescription for their wisdom teeth extraction were 2.7 times more likely to be filling opioid prescriptions weeks or months later, long after the wisdom teeth issue has passed. Particularly, those in their late teens or 20s had the highest odds of persistent opioid use.

Calista Harbaugh, a University of Michigan research fellow and surgical resident, is the lead author of the study. She wanted to assess previously-overlooked side effects associated with a benign procedure like wisdom teeth removal, especially for young people who are opioid-naïve (they haven’t been previously exposed to opioids).

“Wisdom tooth extraction is performed 3.5 million times a year in the United States, and many dentists routinely prescribe opioids in case patients need it for post-procedure pain,” says Harbaugh, a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation (IHPI).

“Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction. We now see that a sizable number go on to fill opioid prescriptions long after we would expect they would need for recovery, and the main predictor of persistent use is whether or not they fill that initial prescription.”

All in all, out of the 56,686 wisdom tooth patients who filled their opioid prescription between 2009 and 2015, 1.3% went on to develop a constant opioid habit, compared to 0.5% of the 14,256 who didn’t file a prescription.

Of course, this is still a correlation, and direct causality has not been established. In other words, there’s a chance that this issue is caused by an external factor. But given the scale of America’s opioid problem, it’s definitely an avenue worth investigating.

Furthermore, it seems that opioids don’t even do much good in this situation.

“There are no prescribing recommendations specifically for wisdom tooth extraction,” Harbaugh said. “With evidence that nonsteroidal anti-inflammatories may just as, if not more, effective, a seven-day opioid recommendation may still be too much.”

Romesh Nalliah, a co-author of the study and the dentist of the team, echoes this feeling. He says that dentists should reduce or stop the prescription of opioids for wisdom teeth removal. Not only will this reduce a potential cause of opioid addiction, but it can also save a lot of money.

“I believe that opioid prescribing for dental procedures can be cut to a fraction of what it is today,” he said. “Through wisdom tooth extraction, the dental profession has an enormous opportunity to fight the opioid crisis by preventing early introduction of opioids to America’s young people. We hope that our study will make my fellow dentists think twice about removing wisdom teeth, and to more strongly consider non-opioid solutions.”

America consumes more opioids than the rest of the world combined. Every day, more than 115 people in the United States die after overdosing on opioids. With roughly 1 in 4 of patients prescribed opioids for chronic pain misusing them, and around 10% of them developing an opioid addiction, any small step towards tackling this issue is more than welcome.

The study has been published in JAMA.

Tabernanthe iboga is a rare plant that grows in the equatorial region of Africa, particularly Cameroon. Credit: Wikimedia Commons.

What is iboga and can it actually cure opioid addiction?

In some circles, iboga — a potent psychedelic drug obtained from the root bark of the African plant Tabernanthe iboga — is hailed as a miracle substance capable of instantly eliminating cravings and withdrawal symptoms for even the most heavily addicted opioid users. But iboga is a potent drug in itself that induces intense hallucinations and potentially deadly side-effects. Anecdotal evidence of iboga’s therapeutic effects for tackling drug abuse and addiction is abundant, but what does the science actually say?

What is iboga

Tabernanthe iboga is a rare plant that grows in the equatorial region of Africa, particularly Cameroon. Credit: Wikimedia Commons.

Tabernanthe iboga is a rare plant that grows in the equatorial region of Africa, particularly Cameroon. Credit: Wikimedia Commons.

Ibogaine (12-methoxyibogamine) is the main alkaloid of at least 12 alkaloids found in the Tabernanthe iboga plant. The substance seems to activate the glial cell line-derived neurotrophic factor (GDNF) pathway in the ventral tegmental area of the brain, increasing its expression. Previous studies have found that the GDNF pathway plays a unique role in mitigating the negative effects of drugs with a high potential for abuse and raises the survivability of adult dopamine-related neurons. The synaptic remodeling may change the responsiveness of the mesolimbic dopaminergic system, thereby canceling the ‘rewarding effect’ and neuroadaptations induced by drug abuse. Such ibogaine-induced changes in GDNF expression may serve to explain the psychedelic drug’s potential efficacy against serious drug addiction.

Does ibogaine work?

The United States is facing a dramatic opioid crisis, with thousands of Americans getting killed annually from overdosing on prescription opioid drugs but also illegal opioids such as heroin. The country has only 5% of the global population, yet consumes 80% of the world’s pharmaceutical opioids.

Credit: Wikimedia Commons.

 

More and more Americans seem to succumb to opioid abuse, a problem exacerbated by a lack of effective treatments against morphine, heroin, methadone, and oxycontin addiction — and this is where iboga might make a difference. According to anecdotal evidence, a single dose is capable of alleviating drug craving and relapse of drug use for a period of time of weeks to months.

Scientists have been aware for decades of the anecdotal therapeutic effects of iboga but research has always been difficult given the drug’s classification as a Schedule I substance, up there with heroin. It is similarly scheduled in 9 of the 28 countries presently in the European Union. However, New Zealand, Brazil, and South Africa have classified ibogaine as a pharmaceutical substance and restrict its use to licensed medical practitioners. Fortunately, some scientists have been allowed to work with iboga and have published their results.

Animal studies suggest that within 24 hours after ingesting ibogaine, the alkaloids produce significant attenuation of opioid withdrawal signs in different animal species. What’s more, the substance also reduces the self-administration of other potent drugs such as cocaine, amphetamine, methamphetamine, alcohol, and nicotine.

In one study performed on humans, involving 33 participants with opioid dependence, withdrawal signs were completely resolved in 29 of the participants (88%). This was not a controlled clinical trial, however.

In a follow-up study conducted in 2004, researchers found that 67% of the 21 participants ceased the use of opioid drugs. The rest (33%) did not end the use of their primary or secondary drugs of abuse but decreased the amount of drug use nevertheless. The overall average drug-free period of all participants was 21.8 months — the median, however, was of 6 months. Another more recent follow-up study published in 2017, which involved 30 participants, 15 subjects (50%) reported no opioid use during the previous 30 days — an effect that “was sustained up to 12 months in a subgroup of subjects.” What’s important to note is that “ibogaine appears to have had a clinical effect in some subjects with histories of failure of other treatments,” the researchers wrote.

The psychological effects of ibogaine

An ibogaine treatment will induce a very intense trip, which has earned it an important place in medicinal and ritual practice in African spiritual traditions of the Bwiti tribe in the Congo basin of Africa.

The iboga trip can be described in three phases:

  • In the first phase (0-1 hours), the alkaloids gradually cause changes in visual, auditory, and body perception. Physical symptoms include dry mouth and difficulty in coordination.
  • The second phase (1-10 hours) is often described as a sort of ‘waking dream’ where the patient undergoes intense visual hallucinations, a buzzing sound, and changes in the perception of time, space, and their own body. Nausea is a common symptom during this phase and patients report feeling physically heavy. The ibogaine visualization during this phase, which occurs with the eyes closed, can be either realistic or symbolic. Testimonies included visions of exotic cultures, deceased people, memories from childhood, or bizarre adventures through one’s own brain or DNA. The hallucinations tend to cease if the patients open their eyes. This phase usually ends abruptly.
  • The third phase (11-36 hours) is regarded as a period of deep introspection. During this phase, patients will generally review memories, often concerning traumatic or emotional experiences, personal relationships, and important life choices. Subjects may find themselves pondering earlier experiences in life, imagining alternatives to their choices. The experience may result in a more responsible attitude towards future life choices but also forgiveness towards oneself and others for past transgressions.

Ibogaine safety

Worldwide, there are more than 3,000 private clinics and retreats were iboga has been established as a “medical subculture.” Thousands of people have so far taken iboga, largely in an unsupervised, non-medical setting (not in the formal sense of the word), with many anecdotally reporting overcoming addiction.

It’s worth noting however that iboga treatment is not without perils. Common physiological side effects during the first phase include nausea, mild tremor, and ataxia. In fact, some people have died after taking iboga, apparently due to a history of other medical conditions.

Between 1990 and 2008, 19 individuals have died within 1.5–76 h of taking ibogaine. In most cases, the deceased had comorbidities and contributing conditions like cardiovascular disease and drug use around the time of treatment. People with a history of heart attack, heart murmurs, arrhythmia, heart operation or severe obesity are advised against taking ibogaine.

In the future, however, it may be possible to experience the positive effects of ibogaine in treating severe opioid addiction without the patient having to deal with side effects. Savant HWP, a pharmaceutical company in California, has developed a drug called 18-MC, which is chemically similar to ibogaine.

According to Scientific American, in 2014, the company completed phase I trials in Brazil with 14 healthy volunteers to determine whether the drug is safe, which they do not plan to publish. Savant HWP’s CEO was quoted saying the company’s formulation was “well tolerated” and there were “no serious adverse effects,” although it was “much more potent than we were expecting.” The drug has now entered phase II clinical trials in California, and if the results are promising, addiction treatment could be drastically changed.

Marijuana legalization helps decrease opioid consumption, research shows

Every day, 90 Americans die from opioid overdoses, according to existing research. Two new studies published in the journal JAMA Internal Medicine now show that in states where marijuana is legal, opioid prescriptions decreased significantly.

Image credits Flickr / Jeffrey Beall.

Researchers have analyzed prescription data from Medicare Part D and Medicaid from the past five years and discovered that opioid prescriptions and the average daily dose of opioids patients took were significantly lower in areas where marijuana is legal.

“In this time when we are so concerned — rightly so — about opiate misuse and abuse and the mortality that’s occurring, we need to be clear-eyed and use evidence to drive our policies,” said W. David Bradford, an economist at the University of Georgia and an author of one of the studies.

“If you’re interested in giving people options for pain management that don’t bring the particular risks that opiates do, states should contemplate turning on dispensary-based cannabis policies.”

Previous research suggests the same. A 2014 paper discovered that in states where cannabis use is legal for medical purposes, nearly 25 percent fewer deaths from opioid overdoses occurred.

One of the studies revealed that Medicare patients filled 14% fewer opioid prescriptions after medical cannabis use became legal. The other study, which monitored Medicaid opioid prescriptions, found that participants filled nearly 40 fewer opioid prescriptions per 1,000 people (4%) each year after their state passed laws that made cannabis accessible — states that legalized both medical and recreational marijuana showed greater falls in opioid prescriptions.

With the arrival of fentanyl on the black market, doctors fear we’ll see even more cases opioid overdose. This powerful opioid is up to 100 times more potent than morphine. Due to its powerful effect, fentanyl doses are very small, which is actually a problem. Overdoses usually occur when miscalculating the amount of drug administered, and it’s easier to go wrong with smaller doses. When fentanyl became a go-to drug for dealers, opioid deaths immediately spiked due to its high potency at low doses. Basically, people did not know that surpassing the dosage with only a few micrograms might be fatal.

So, the findings seem positive from a public health point of view. Marijuana is generally perceived as ‘safe’, and according to The National Center for Biotechnology Information, there is insufficient evidence to support or refute a statistical association between cannabis use and death due to cannabis overdose — in other words, there’s not enough data to say that cannabis use can or cannot be fatal, which, relative to fentanyl, makes it super-duper safe.

One recent paper even suggested that opioids didn’t provide any more relief for chronic arthritis pain than over-the-counter painkillers.

The studies also discovered differences in decline in opioid prescription between the states that legalized medical marijuana: states with dispensaries open for business saw the greatest decrease in opioid prescriptions, while states without active dispensaries saw a far less dramatic decline — about 14% and 7%, respectively

Bradford said that this made sense. The difference between picking up ready-to-use marijuana and growing your own plant with little support from the authorities is huge.

One impediment in substituting opioids with marijuana is that neither Medicaid nor Medicare will reimburse people for the money they spend on marijuana.

“I did a back-of-the-envelope calculation that suggested that a daily pain management dose of hydrocodone would be about $10 out of pocket in the U.S,” Bradford said, although Medicare Part D plans cover much of that.

Last year, a daily dose of marijuana cost around $6 — and that sum should be smaller by now, Bradford said. “It’s becoming relatively comparable in cost.”

“I know policymakers are often skeptical of cannabis. But we need to be terrified of things like fentanyl, and we need to be willing to use evidence-based approaches to help address that,” Bradford added. “Cannabis looks like it could be one,” he concluded.

Vintage Chinese opium session. Credit: Public Domain.

International drug treaties need an urgent revamp as more countries legalize cannabis

Recent moves toward the legalization of cannabis use, farming, and distribution across several countries like the United States, Canada, or Uruguay is casting doubts on the future of international drug treaties. Such legislative changes essentially violate drug control treaties endorsed by most member states of the United Nations (UN). One scholar argues that these international frameworks are outdated and require urgent reform. His paper outlines several suggestions for the incremental reform of liberal drug policies instead of decriminalizing drugs with high abuse potential head on.

Addiction, war, and treaties

Vintage Chinese opium session. Credit: Public Domain.

Vintage Chinese opium session. Credit: Public Domain.

Nearly 100 years ago, in 1909, the international community met in Shanghai to find a solution to the single largest drug problem the world has ever had: the Chinese opioid epidemic. At its peak, the opioid trade affected tens of millions of Chinese who were addicted to the drug, with nearly a quarter of the country’s adult male population using it annually.

This was a huge problem for China, as the drug trade not only took a toll on its working population but also dwindled its foreign reserves which were funneled into opium imports. Earlier, in the mid-19th century, China even went to war with the British Empire twice following an opium embargo. It ended disastrously and China was not only forced to lift the opium embargo but also cede the island of Hong Kong to the British.

You see, opium was not only addictive to its entrenched consumers, but to many governments who filled their treasury coffers with handsome profits. British India, for instance, derived 14% of state income from its opium monopoly in 1880. And after its two wars with the British which forced China to open opium trade, the latter simply started to grow its own poppy domestically.  At the time of the Shanghai Commission, China derived at least 14% of its income from the drug through taxation.

While seemingly successful in its stated goal of curbing international drug trade, the Shanghai Commission was a non-binding agreement. The first international drug convention, the International Opium Convention of The Hague, was signed in 1912 and entered into force in 1915. This was the first truly international instrument for dealing with drug trade which required signatories to enforce anti-narcotics policies.

The scope of controlled substances was gradually expanded from opium and morphine (Recommendations of the Shanghai Conference, 1909) to cocaine (The Hague Convention, 1912), cannabis (1925 Convention), synthetic opiates (1948 Protocol), psychotropic substances (Convention on Psychotropic Substances, 1971) and precursor chemicals (1988 United Nations Convention
against Illicit Traffic in Narcotic Drugs and Psychotropic Substances).

The aim of all these treaties was to reduce the harmful use of prohibited drugs and facilitate access to these drugs for medical and scientific purposes. Over time results started to show.

“For those who doubt the effectiveness of drug control, consider this. In 1906, 25 million people were using opium in the world (1.5% of the world population) compared with 16.5 [million] opiate users today (0.25% of the world population). In 1906/07, the world produced around 41,000 tons of opium – five times the global level of illicit opium production in 2008. While opium used to be produced in a huge belt, stretching from China to Indochina, Burma, India, Persia, Turkey and the Balkan countries, the illegal production of opium is now concentrated in Afghanistan (92%),” wrote Antonio Maria Costa, Executive Director United Nations Office on Drugs and Crime in a report called Drug Control 1909-2009:A Positive Balance Sheet.

“Same for coca. Its leaves used to be cultivated not only in the Andean region but also in several Asian countries including Java (Indonesia), Formosa (Taiwan) and Ceylon (Sri Lanka). Today coca leaf production is concentrated in three Andean countries: Colombia, Peru and Bolivia,” he added.

Drug control treaties need to face a new reality

People protest against Philippine President Rodrigo Duterte's war on drugs. The death toll so far is estimated at 13,000. Credit: Flickr, Wikimedia Commons.

People protest against Philippine President Rodrigo Duterte’s war on drugs. The death toll so far is estimated at 13,000. Credit: Flickr, Wikimedia Commons.

But critics claim that the treaties have failed to tackle non-medical use of prohibited drugs and have justified policies that conflict with UN human rights treaties by incarcerating large numbers of drug users. The famous ‘war on drugs’ has failed at the expense of billions in taxpayers’ money and thousands of users who faced prison.

Despite considerable resources devoted to controlling illicit substances, the United States is now facing its own opioid epidemic. In the last decade alone, the number of heroin users have grown fivefold with young, white males being the most vulnerable group. Since the year 2000, the number of deaths from heroin overdose has quadrupled.

Many governments have now relaxed drug control to the point of decriminalization or downright legalization as is the case of cannabis in Uruguay or Nevada. Professor Wayne Hall, whose 2014 review of 20 years of cannabis research made world headlines, stresses that these measures violate a number of drug control treaties.

“A major impediment to any nation abandoning the policy of drug prohibition has been the fact that international drug treaties to which the majority of United Nations (UN) member states are signatory prohibit the non-medical use of amphetamines, cannabis, cocaine and heroin. The future of these treaties is now uncertain because of decisions by Uruguay, eight US states and Canada to legalize cannabis use,” he wrote.

Hall cautions in a new paper published in Addiction that if decriminalization is the way to go in the future, the future of such drug treaties comes in doubt. They can not disappear entirely either as this would come at the cost of public health.

Hall argues policy reforms should involve trialing and evaluating the effects of incrementally more liberal drug policies. Some of his most important suggestions include:

  • Cannabis: This is the strongest candidate for national policy experiments on different ways of regulating its sale and use. This is happening in the USA, Uruguay, and Canada. Rigorous evaluations of these experiments will be useful for other countries considering legalizing cannabis for adult recreational use.
  • Party drugs, such as ecstasy, LSD, and novel psychoactive substances: The most important regulatory challenge for those who advocate more liberal policies are ensuring that drug manufacture and sale meet reasonable standards of consumer safety and that consumers are well informed about the risks of using these drugs.
  • Opioids: The best way forward may be a mitigated form of prohibition. Mitigated prohibition differs from a ‘war on drugs’ by expanding treatment for opioid dependence, reducing some of its serious medical complications, and reducing the number of opioid users who are imprisoned.
  • Cocaine and amphetamines: There are no easy answers here. Proposed regulation via a modified prescription system seems unlikely to reduce harmful use. Prohibition may minimize use but it is not sufficient, because stimulants are very easy to produce illicitly. Stimulant policy needs better ways of reducing the demand for stimulants and more effective treatments for problem stimulant users.

 

This heroin vaccine might solve part of our growing opioid addiction problems

Heroin needle found in the gutter. Credit: Wikimedia Commons.

Heroin needle found in the gutter. Credit: Wikimedia Commons.

An estimated 9.2 million people in the world use heroin, and the United States is one of the hardest hit countries. In the last decade alone, heroin users have grown fivefold with young, white males being the most vulnerable group. Since the year 2000, the number of deaths from heroin overdose has quadrupled. Many blame lax use of prescription opioid painkillers — narcotics such as Oxycontin, Percocet, and Vicodin – which are seen as gate way drugs for smack. Culprits aside, it’s clear that we need solutions to what can only be called double opioid and heroin epidemic.

It might sound odd to call heroin addiction an epidemic but really no other medical term captures the rapid spread and health consequences that we see in heroin use today. And if indeed heroin addiction is an epidemic that perhaps we can treat it like we would the measles or polio: with a vaccine. American researchers at the Scripps Research Institute are working on just that and according to a recent report, progress is encouraging enough to warrant a clinical trial soon.

Immunizing against heroin, now seemingly possible

The idea is to develop a shot that nullifies heroin’s high. Minutes after heroin’s morphine chemicals enter the blood stream and bind to opioid receptors in the brain, users report an intense feeling of euphoria as if a ‘warm blanket snuggled the brain’. A vaccine, however, would block the morphine from binding to receptors and hence cancel its effects. Taken long enough and devoid of any physical high, the cycle of addiction could be broken in some cases or at least that’s what doctors hope.

Of course, there are already some drugs that block heroin’s psychoactive effects (such as Naltrexone). However, these drugs, taken orally as a pill, need to be administered regularly whereas a vaccine is given once and provides long-term protection. A vaccine is much more desirable in the case of heroin drug abuse since users battling with withdrawal most often than not can’t muster the required discipline to take their pills.

A notion of a vaccine for various drug addictions isn’t novel at all. Scientists in the 1970s investigated vaccines for all sorts of addictions from cocaine to nicotine to amphetamines. These early attempts have been unsuccessful and interest was lost though somewhat renewed by some research groups in the 1990s.

One big problem that has made research difficult is the fact that drugs like amphetamine or heroin have small molecules. In order to set off an immune response like any vaccine would do, it then becomes necessary to bind these molecules with larger ones, such as a protein. The hapten-carrier can then train the body to fight off real heroin once it enters the blood stream, an effect which can be amplified by secondary chemicals called adjuvants in the vaccine.

Credit: Scripps.

The Scripps vaccine is carefully crafted with the right mix of hapten, carrier, and adjuvant. Specifically, the vaccine has tetanus toxoid core — the same as in the better-known tetanus vaccine — formulated with adjuvants alum and CpG oligodeoxynucleotide (ODN).

Tests on mice and rhesus monkeys suggest the researchers’ vaccine blocks heroin effects for at least eight months if injected every three months. What’s more, other tests suggest the vaccine can also protect users from overdoses, which often result in death.

“[…] [The vaccine] generated heroin “immunoantagonism”, reducing heroin potency by >15-fold.”

“Following a series of heroin challenges over six months in vaccinated monkeys, drug-sequestering antibodies caused marked attenuation of heroin potency (>4-fold) in a schedule-controlled responding (SCR) behavioral assay. Overall, these preclinical results provide an empirical foundation supporting the further evaluation and potential clinical utility of an effective heroin vaccine in treating opioid use disorders,” the authors wrote.

These are all extremely encouraging results, which is why many are so keen to start a clinical trial as a soon as possible, within a few years.

Critics caution, however, that a heroin vaccine isn’t a magic fix for our growing heroin abuse epidemic. For one, such a vaccine can only work in those cases where users wish to stop or where existing treatment such as those involving methadone are inadequate. People end up abusing heroin for a variety of reasons and there’s only so much a vaccine can do.

Medical Marijuana.

Is lighting up the answer to America’s opioid epidemic?

Given a choice between opioids and medical marijuana to keep pain under control, an overwhelming majority of patients who have used both would pick the latter, saying it works just as well and with fewer side effects, a new survey shows.

Medical Marijuana.

Image credits Dank Depot / Flickr.

The study didn’t track actual drug use or their efficacy but rather aimed to get a feel for how patients would behave given a viable alternative to opioid medication. Such insight into patient choice is critical today, as the US struggles under its worst drug epidemic in history — the Centers for Disease Control and Prevention reports that opioids killed more than 33,000 Americans in 2015. The CDC further estimates that some 91 Americans lose their lives because of the highly addictive drugs every day.

Options not Overdose

But the findings give cause for hope than things can change. The team, led by Amanda Reiman of the University of California, Berkeley, collaborated with HelloMD, an online community for medical cannabis patients (they weren’t funded by HelloMD) to survey 2,897 medical cannabis users on how they use opioid medicine and weed to manage chronic pain. Of the participants, 63% were already using marijuana for pain-related conditions at the time of the survey, and roughly 30% (841) reported using an opioid currently or in the past six months.

Of these 841 patients, 92% agreed or strongly agreed that they would prefer cannabis over opioids for their condition. Funnily enough, slightly more (93%) agreed or strongly agreed that they’d go with cannabis if both options were available. About 71% say cannabis is just as effective in relieving their pain as opioids, and 97% said cannabis use helps them cut down on how many opioids are needed to keep pain levels under control.

Figure 2 use of cannabis and opiates.

Image credits Reiman et al., 2017.

The researchers found similar results when they asked about non-opioid pain medication use.

Figure 3 use of cannabis and non-opiates.

Image credits Reiman et al., 2017.

Literature backs up these participants’ opinion on the issue up to a point. Decades of research have shown that cannabis is effective in treating pain although not on the same level as opiates, and states where medical marijuana is available report fewer opioid overdoses and fewer opioid prescriptions than the rest. And since it’s virtually impossible to get a cannabis overdose, its use in conjunction with or in lieu of opioid medicine could help patients reduce opioid intake, avoid addiction, and in the end help save lives.

“Supporting the results of previous research, this study can conclude that medical cannabis patients report successfully using cannabis along with or as a substitute for opioid-based pain medication,” the authors write.

“[…] patients in this study who are using cannabis and opioids report that they are able to use less opioids and that cannabis presents less unwanted side effects than their opioid-based medication.”

The authors say that there are a few limitations with the study. For starters, they had to work with a self-selected group of cannabis users, so the data may be biased. It also doesn’t look at actual efficacy or use, just perceptions — which may be inconsistent and can be skewed.

Still, they believe the results warrant further work with marijuana as a “viable substitute for pain treatment.” Until such work is performed, they recommend working on what data we do have and provide patients with a choice between opioids and other treatment options to help reduce pain and risks at the same time.

“A society with less opioid dependent people will result in fewer public health harms,” they conclude.

The full paper “Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report” has been published in the journal Cannabis and Cannabinoid Research.

A sea-snail’s venom could rival opioids in pain relief capability

University of Utah researchers have identified a compound that could offer an alternative to opioids. Sourced from the venom of a small marine snail Conus regius, it blocks pain by targeting a non-opioid pathway in the brain.

Image credits James St. John / Flickr.

Opioids are very good at blocking pain, making them invaluable for medical applications. But they’re also very good at being addictive, which is a big problem. The CDC reports that some 91 people die from opioid overdose every day in the US alone and they always come back for more.

An alternative to opioids

So an alternative painkiller, one that doesn’t rely on the same brain structures as opioids but has the same punch, is needed. An alternative that the Conus regius, a small cone snail native to the Caribbean Sea, is poised to offer — this predatory critter’s venom, used to paralyze and kill prey, shows promise as a powerful painkiller.

“Nature has evolved molecules that are extremely sophisticated and can have unexpected applications,” begins Baldomera Olivera, Ph.D., professor in biology at the University of Utah.

“We were interested in using venoms to understand different pathways in the nervous system.”

The paper describes a compound isolated from the snail’s venom, called RglA, which acts through a different pathway than that targeted by opioid drugs. Rat studies have shown that its analog RglA4 can block α9α10 nicotinic acetylcholine pain receptors, effectively shutting down this pain pathway. Not only that, but the effect lasts for a long time, even after the substance has been cleared from the rat’s system (which took about 4 hours.) This would suggest that RglA4 has effects that go beyond numbing the sensation of pain — such as a regenerative effect on the nervous system.

“We found that the compound was still working 72 hours after the injection, still preventing pain,” said J. Michael McIntosh, M.D., professor of psychiatry at the University of Utah Health Sciences.

“What is particularly exciting about these results is the aspect of prevention,” he added. “Once chronic pain has developed, it is difficult to treat. This compound offers a potential new pathway to prevent pain from developing in the first place and offer a new therapy to patients who have run out of options.”

Rodent trials

To check if the substance would work on humans, the team took RglA and created 20 analogs of the compound. In essence, they took the bit that fits into the receptors, and put together slightly different configurations of it to see which one worked best. The analog RgIA4 was the one who bound the strongest to the human receptors.

To see how effective it would be as a painkiller, the team administered RglA4 to rodents who had previously been treated with a chemotherapy drug that induces extreme cold sensitivity and touch hypersensitivity. The team also set up two control groups — one which group was treated but didn’t receive RglA4, and one who was genetically modified to lack α9α10 receptors.

“Interactions that are not normally painful, like sheets rubbing against the body or pants against the leg, becomes painful,” said McIntosh.

The rodents who received RglA4 and the genetically altered control group didn’t show any signs of pain, but the other control group did.

“RgIA4 works by an entirely new pathway, which opens the door for new opportunities to treat pain,” McIntosh added.

“We feel that drugs that work by this pathway may reduce burden of opioid use.”

The full paper “Inhibition of α9α10 nicotinic acetylcholine receptors prevents chemotherapy-induced neuropathic pain” has been published online in the journal PNAS.

In the long run, morphine might actually cause more pain than it alleviates

Painkillers in the opium family (most notably morphine) may actually make pain last longer, a new study reports. Morphine treatment after a nerve injury doubled the duration of pain in rats and this is highly worrying.

Morphine treatment extended the duration of nerve pain in rats, a result that raises questions about the effects of other opioid-based painkillers, such as OxyContin.

It gets even more disturbing when you consider the addictive potential of many commercial opioids such as OxyContin and Vicodin. If this is true, then people are becoming addicted to something that’s extending their pain even longer, suggesting that “the treatment is actually contributing to the problem,” says study coauthor Peter Grace, a neuroscientist at the University of Colorado Boulder.

It’s not the first time opioids have been discussed in this context. Doctors have known for a while that for some people, opioids enhance the pain sensitivity, a condition called opioid-induced hyperalgesia. In this new study, the negative effects lingered for a few weeks even after the treatment was stopped. These experiments were done with male rats, but unpublished data indicate that morphine extends pain even longer in female rats, Grace says. Previous studies suggest there wouldn’t be any major difference between male and female results.

However, this is still just a rat study, and we don’t know if the same effects would be exhibited in humans, nor is it known if all opioids behave similarly. Clarity on how opioids influence pain could change doctors’ prescribing habits and promote better treatments, but the study has to be replicated in humans before we can draw any definite conclusions.

Journal reference: P. M. Grace et al. Morphine paradoxically prolongs neuropathic pain in rats by amplifying spinal NLRP3 inflammasome activation.Proceedings of the National Academy of Sciences. Published online the week of May 30, 2016. doi: 10.1073/pnas.1602070113.