Timothy P. Condon

Drugs of Abuse and the Aging Brain

Substance abuse among older adults has received little attention in the past, presumably because this population has traditionally accounted for only a small percentage of the drug abuse problem in the United States. The aging of the baby boomer generation (born 1946–1964), however, will soon swell the ranks of older adults and dramatically alter the demography of American society. Several observations suggest that this expansion will likely be accompanied by a precipitous increase in the abuse of drugs, including prescription medications and illicit substances, among older adults. While it is now evident that the brain changes continuously across life, how drugs of abuse interact with these age-related changes remains unclear. The dynamic nature of brain function, however, suggests that substance abuse during older age may augment the risks and require unique considerations for diagnosis and treatment. In addition to describing current and projected prevalence estimates of substance abuse among older adults, the present review discusses how aging affects brain systems involved in drug abuse, and explores the potential impact of drug abuse on the aging brain. Future directions for substance abuse research among older adults will also be considered.

Partnerships and pathways of dissemination: The National Institute on Drug Abuse—Substance Abuse and Mental Health Services Administration Blending Initiative in the Clinical Trials Network

Since 2001, the National Drug Abuse Treatment Clinical Trials Network (CTN) has worked to put the results of its trials into the hands of community treatment programs, in large part through its participation in the National Institute on Drug Abuse-Substance Abuse and Mental Health Services Administration Blending Initiative and its close involvement with the Center for Substance Abuse Treatments Addiction Technology Transfer Centers. This article describes (a) the CTNs integral role in the Blending Initiative, (b) key partnerships and dissemination pathways through which the results of CTN trials are developed into blending products and then transferred to community treatment programs, and (c) three blending initiatives involving buprenorphine, motivational incentives, and motivational interviewing. The Blending Initiative has resulted in high utilization of its products, preparation of more than 200 regional trainers, widespread training of service providers in most U.S. States, Puerto Rico, and the U.S. Virgin Islands and movement toward the development of Web-based implementation supports and technical assistance. Implications for future directions of the Blending Initiative and opportunities for research are discussed.

Blending addiction research and practice: Strategies for technology transfer

Consistent with traditional conceptions of technology transfer, efforts to translate substance abuse and addiction research into treatment practice have typically relied on the passive dissemination of research findings. The large gap between addiction research and practice, however, indicates that there are many barriers to successful technology transfer and that dissemination alone is not sufficient to produce lasting changes in addiction treatment. To accelerate the translation of research into practice, the National Institute on Drug Abuse launched the Blending Initiative in 2001. In part a collaboration with the Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatments Addiction Technology Transfer Center program, this initiative aims to improve the development, effectiveness, and usability of evidence-based practices and reduce the obstacles to their timely adoption and implementation.

Prescription drug monitoring programs-lack of effectiveness or a call to action?

Prescription opioid pain relievers play an essential role in improving the quality of life for millions of Americans each year. However, over the last decade, the legitimate use as well as the misuse and abuse of prescription opioids have increased dramatically. From 1997 to 2007, the milligram per person use of prescription opioids in the United States increased from 74 mg to 369 mg per person, an increase of 402% [1]. In addition, the health and economic consequences of opioid abuse are exacting a significant toll—with over five million Americans, 12 years of age and older, reporting nonmedical use of prescription opioids in 2009 [2]. From 2004 to 2008, there was a 111% increase in emergency room visits for misuse or abuse of prescription opioids [3], and this was paralleled with a fourfold increase in treatment admissions for abuse of opioids over the last decade [4]. Most alarming is a nearly 300% increase in opioid-related deaths between 1999 and 2007 [5]. Prescription drug abuse is a public health epidemic, and comprehensive policies must be developed to minimize abuse while ensuring legitimate access to these medications. Prescription drug monitoring programs (PDMPs) are a promising tool to assist health care providers in clinical decision-making and to identify patients who may be misusing or abusing prescription drugs. Although studies have shown that PDMPs shorten investigation times [6] and reduce the supply of certain Schedule II controlled …

Injectable pharmacotherapy for opioid use disorders (IPOD)

BACKGROUND Despite the growing prevalence of opioid use among offenders, pharmacotherapy remains an underused treatment approach in correctional settings. The aim of this 4-year trial is to assess the clinical utility, effectiveness, and cost implications of extended-release naltrexone (XR-NTX, Vivitrol®; Alkermes Inc.) alone and in conjunction with patient navigation for jail inmates with opioid use disorder (OUD). METHODS Opioid-dependent inmates will be randomly assigned to one of three treatment conditions before being released to the community to include: 1) XR-NTX only; 2) XR-NTX plus patient navigation (PN), and 3) enhanced treatment-as-usual (ETAU) with drug education and a community treatment referral. Before release from jail, participants in the XR-NTX and XR-NTX plus PN conditions will receive their first XR-NTX injection. Those in the XR-NTX plus PN condition also will meet with a patient navigator. Participants in both XR-NTX conditions will be scheduled for medical management sessions twice monthly for months 1-3, monthly medical management sessions for months 4-6, with monthly injections for 5months post-release (which, given the pre-release injection, results in a 6-month medication phase). Follow-up data collection will occur at 1, 3, 6, and 12months post release. RESULTS We discuss the studys rationale, aims, methods, and anticipated findings. The primary outcome is the presence of a DSM 5 OUD diagnosis 1year after randomization (6months after the end of the active treatment phase). DISCUSSION We hypothesize that providing XR-NTX prior to release from jail will be particularly beneficial for this extremely high-risk population by reducing opioid use, associated criminal behavior, and injection-related disease risk. ClinicalTrials.Gov: NCT02110264.

The SOMATICS collaborative: introduction to a National Institute on Drug Abuse cooperative study of pharmacotherapy for opioid treatment in criminal justice settings

BACKGROUND Among the nearly 750,000 inmates in U.S. jails, 12% report using opioids regularly, 8% report use in the month prior to their offense, and 4% report use at the time of their offense. Although ample evidence exists that medications effectively treat Opiate Use Disorder (OUD) in the community, strong evidence is lacking in jail settings. The general lack of medications for OUD in jail settings may place persons suffering from OUD at high risk for relapse to drug use and overdose following release from jail. METHODS The three study sites in this collaborative are pooling data for secondary analyses from three open-label randomized effectiveness trials comparing: (1) the initiation of extended-release naltrexone [XR-NTX] in Sites 1 and 2 and interim methadone in Site 3 with enhanced treatment-as usual (ETAU); (2) the additional benefit of patient navigation plus medications at Sites 2 and 3 vs. medication alone vs. ETAU. Participants are adults with OUD incarcerated in jail and transitioning to the community. RESULTS We describe the rationale, specific aims, and designs of three separate studies harmonized to enhance their scientific yield to investigate how to best prevent jail inmates from relapsing to opioid use and associated problems as they transition back to the community. CONCLUSIONS Conducting drug abuse research during incarceration is challenging and study designs with data harmonization across different sites can increase the potential value of research to develop effective treatments for individuals in jail with OUD.

71 – Neurobiology of Drug Addiction

Drug addiction is a chronic relapsing disorder characterized by compulsive drug seeking and taking that occurs at the expense of important activities and despite adverse consequences, including severely impaired social relationships and occupational function, medical illness, and incarceration. Homeostatic neuroadaptive responses to repeated drug exposure, however, produce tolerance, withdrawal, or both, which manifest as decreases in the pleasure experienced with the same amount of drug and increasingly unpleasant withdrawal symptoms when drug taking ceases. Several factors including intensity, duration, and predictability, influence the extent to which various stressors facilitate drug-taking behaviors. Animal studies suggest that drug craving, rather than being greatest immediately following withdrawal, as might intuitively seem to be the case, may incubate or increase steadily over several weeks or months to elevated levels that persist for an extended period before decreasing. This chapter reports that the incubation of cocaine craving reported in cocaine-dependent lab animals reflects long-lasting drug-induced changes in glutamate receptor regulation observed in several brain regions. These findings and interpretations would seem to suggest that neuroadaptations induced by repeated drug exposure are critical mediators of the vulnerability to relapse. However, much remains to be learned before the contribution of drug-induced adaptations to relapse in humans can be defined with certainty.