Single cell transcriptomics reveals distinct transcriptional responses to oxycodone and buprenorphine by iPSC-derived brain organoids from patients with opioid use disorder.

The opioid epidemic represents a national crisis. Oxycodone is one of the most prescribed opioid medications in the United States, whereas buprenorphine is currently the most prescribed medication for opioid use disorder (OUD) pharmacotherapy. Given the extensive use of prescription opioids and the global opioid epidemic, it is essential to understand how opioids modulate brain cell type function at the single-cell level.

Medication-assisted treatment for opioid use disorder within a 12-step based treatment center: Feasibility and initial results.

Rationale: Opioid overdose deaths and healthcare costs associated with opioid use disorder (OUD) continue to escalate while the majority of addiction treatment providers in the United States do not use medication-assisted treatment (MAT) in spite of proven efficacy. The primary resistance to the use of MAT has been associated with the philosophical conflict many 12-step based treatment programs have with the use of these medications.

Objective: This study sought to determine whether patients self-selecting into a treatment program based upon the 12-step philosophy would elect to use MAT and, if so, what initial outcomes might result.

Sex-specific association of depressive disorder and transient emotional states with alcohol consumption in male and female alcoholics.

Background: We assessed the impact of comorbid depression and anxiety disorders as well as positive and negative emotional states on alcohol consumption in alcohol dependent men and women.

Methods: Per day alcohol consumption during 90 days before enrolment was assessed by the Time Line Follow Back (TLFB) in 287 men and 156 women meeting DSM-IV-TR criteria for alcohol dependence. Propensity to drink in negative/positive emotional states was assessed using the Inventory of Drug Taking Situations (IDTS).

The three missing elements in the treatment of substance use disorders: Lessons from the physician health programs.

To make recovery, and not relapse, the expected outcome of the treatment of moderate to severe substance use disorders, 3 currently missing elements would need to be emphasized: (1) the definition of long-term recovery as the goal of all treatment and post-treatment interventions; (2) the provision of sustained post-treatment monitoring and professional and peer support, including drug testing; and (3) the insistence by others around the patients on sustained abstinence as crucial for those suffering from moderate to severe and prolonged substance use disorders. Each of these 3 elements is central to the distinctive care management system of the state physician health programs. This approach to the long-term management of substance use disorders fits with the new direction of healthcare for serious, chronic diseases-away from isolated, and expensive acute care episodes of care and toward sustained chronic disease management with long-term monitoring, support, and early re-intervention if and when needed.

A comprehensive response to the opioid epidemic: Hazelden's approach.

For years, treatment professionals have debated the virtues of medication maintenance versus psychosocial therapies for treating opioid addiction. In its response to the opioid crisis, Hazelden is attempting to bridge the difference by using a treatment protocol that involves both the conservative use of safe medications and psychosocial therapies while maintaining the ultimate goal of abstinence. This article discusses the recent and precipitous rise in opioid use, abuse, dependence and overdoses in the United States; the physician's role in creating and solving the problem; and Hazelden's unique approach to caring for people with opioid addiction.

The addicted physician. A rational response to an irrational disease.

Physicians are as likely to experience drug and alcohol addiction as anyone in the general population. They are more likely than others, however, to abuse prescription medications. Dealing with an impaired colleague is a difficult, emotionally charged job for physician leaders and hospital administrators, who've often had little training on how to handle such a situation.

Chemical dependency and the physician.

Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention.

Patients with pain and addiction: what's a doctor to do?

Significant improvements in the evaluation and treatment of pain have led to more prescribing of and increased pressure to prescribe a variety of potentially addictive drugs to patients who are suffering from acute and chronic pain. Although these drugs serve an important purpose, they present risks to patients who are in recovery from addiction, are currently addicted, or have a family history of addiction. This article presents an overview of the concerns physicians face when treating such patients and outlines strategies for safely using these drugs.