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Resurgence of Illicit Stimulants in the Ongoing Substance Use Disorder Epidemic - notes below https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">

#CPDD20

Matthew Ellis (WUSTL)...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Overdose deaths related to coc and meth increased dramatically starting ~ 2015. In 2017, cocaine is third (just behind heroin) re: total overdoses.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Amph-related hospitalizations have steadily increased since 2008 in *all populations*.

Matthew Ellis (WUSTL), cont& #39;d...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Treatment admissions for cocaine have *decreased* (at odds w/ stable + increased indices of abuse/overdose.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Cocaine use tends to track w/ fentanyl use (re: overdoses).
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Motivations for co-use (stim. & opioid): energize day, sedate at night.

Kathleen Carroll (Yale)...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Metanalysis re: psychosocial intervention for coc/amph use disorders - contingency management (CM) was "clear winner".
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">For meth use disorder - CM, CBT, and exercise demonstrated clear efficacy (seemingly less convincing re: transcranial stim).

Kathleen Carroll (Yale), cont& #39;d...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Where to head? Contingency management (CM) is best treatment. Sets "high bar" for pharmacotherapy for stim. use disorders that does better than CM.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Non-abstinence based measures - *reductions* in use correlate w/ psychosocial functioning.

Frances Levin (Columbia)...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Three pharmacotherapuetic frontrunners for stim. use disorders: topiramate, modafinil, & stimulants (not much evidence *does not mean not effective*).
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Only 10 drugs (as of 2016) across non-human primates, human lab, and clinical treatment trial.

Frances Levin (Columbia), cont& #39;d...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">DA agonist-based therapy: heavy stim. users have depleted DA functioning which map symptoms (e.g., cog. functioning); good patient acceptance; some concern w/ cardiovas. effects; dextroamph. *long-acting* effective vs. short-acting for CUD.

Frances Levin (Columbia), cont& #39;d...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Intervention that first uses beh. therapy (CM) and then assesses outcome... if ineffective, add agonist-based therapy + reassess (more than just abstinence).
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Extended-release amph + topiramate were most effective against severe coc. users.

Chang-Guo Zhan (U. Kentucky)...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Preclinical development of pharmacotherapies for stim. use disorders: small molecules, vaccines (active immunity), mAbs (passive immunity), metabolic enzyme approach (gene therapy).

Chang-Guo Zhan (U. Kentucky), cont& #39;d...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉" title="Rückhand Zeigefinger nach rechts" aria-label="Emoji: Rückhand Zeigefinger nach rechts">Anticocaine enzymes: cocaine esterase, human butyrylcholinesterase (TV-1380... PK profile is poor... new, longer-acting form (CocH5-FC(M6)) completely blocks coc. self-admin. in rats.

Newly-engineered long-acting cocaine hydrolase mutant enzymes show high binding affinity, prolonged biological half-life, effective against beh. effects of cocaine in rats.

From Chang-Guo Zhan (U. Kentucky). See more here https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten"> #CPDD20 https://pubmed.ncbi.nlm.nih.gov/32189158/ ">https://pubmed.ncbi.nlm.nih.gov/32189158/...