Addiction Medicine and Addiction Psychiatry Updates

Research is sparse and definitions aren't consistent, experts say. " Taking small doses of psychedelics, referred to as "microdosing," has become increasingly popular, but little is known about the safety or efficacy of the trend." https://www.medpagetoday.com/popmedicine/cultureclinic/111085

Eight weeks of acupuncture were superior to sham acupuncture in reducing methadone dose and decreasing opioid craving. Liming Lu, Chen Chen, Yiming Chen, et al.  Effect of Acupuncture for Methadone Reduction : A Randomized Clinical Trial .  Ann Intern Med.   [Epub 9 July 2024]. doi: 10.7326/M23-2721   https://www.acpjournals.org/doi/10.7326/M23-2721

" Roughly 60%  of people who are incarcerated have a substance use disorder, in many cases an opioid use disorder. When people with addiction leave prison or jail and return to their communities, they are at very high risk of returning to drug use and overdosing. Their tolerance to drugs has diminished during incarceration, and fentanyl is pervasive in the street drug supply. Even one relapse could be fatal. It  remains a common belief   that simply stopping someone from taking drugs while in jail or prison is an effective approach to treatment. But that belief is inaccurate and dangerous...." https://www.statnews.com/2024/07/09/providing-addiction-treatment-prisons-jails/

Heroin use disorder in humans and chronic opioid administration to mice result in an increase in the number and a decrease in the size of detected hypocretin (Hcrt, or orexin) neurons. Chronic morphine administration to mice increases Hcrt axonal projections to the ventral tegmental area (VTA), the level of tyrosine hydroxylase (TH) in VTA and the number of detected TH +  cells in VTA, and activates VTA and hypothalamic microglia. Co-administration of morphine with the dual Hcrt receptor antagonist suvorexant prevents morphine-induced changes in the number and size of Hcrt neurons, the increase in Hcrt projections to the VTA and microglial activation in the VTA and hypothalamus. Co-administration of suvorexant with morphine also prevents morphine anticipatory behavior and reduces opioid withdrawal symptoms. However, suvorexant does not diminish morphine analgesia. Here we show that combined administration of opioids and suvorexant may reduce the addiction potential of opioid use for pa

The results indicate that OXR signaling in the pPVT is critical for stress-induced reinstatement of oxycodone seeking, further corroborating OXRs as treatment targets for opioid use disorder. Jessica M Illenberger, Francisco J Flores-Ramirez, Glenn Pascasio, Marissa Franco, Brandon Mendonsa, Rémi Martin-Fardon.  Pivotal role of orexin signaling in the posterior paraventricular nucleus of the thalamus during the stress-induced reinstatement of oxycodone-seeking behavior .   Journal of Psychopharmacology , 2024; DOI:   10.1177/02698811241260989