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Resurgence of Illicit Stimulants in the Ongoing Substance Use Disorder Epidemic - notes below
#CPDD20
Resurgence of Illicit Stimulants in the Ongoing Substance Use Disorder Epidemic - notes below
#CPDD20
Matthew Ellis (WUSTL)...
Overdose deaths related to coc and meth increased dramatically starting ~ 2015. In 2017, cocaine is third (just behind heroin) re: total overdoses.
Amph-related hospitalizations have steadily increased since 2008 in *all populations*.
Overdose deaths related to coc and meth increased dramatically starting ~ 2015. In 2017, cocaine is third (just behind heroin) re: total overdoses.Amph-related hospitalizations have steadily increased since 2008 in *all populations*.
Matthew Ellis (WUSTL), cont'd...
Treatment admissions for cocaine have *decreased* (at odds w/ stable + increased indices of abuse/overdose.
Cocaine use tends to track w/ fentanyl use (re: overdoses).
Motivations for co-use (stim. & opioid): energize day, sedate at night.
Treatment admissions for cocaine have *decreased* (at odds w/ stable + increased indices of abuse/overdose.Cocaine use tends to track w/ fentanyl use (re: overdoses).Motivations for co-use (stim. & opioid): energize day, sedate at night.
Kathleen Carroll (Yale)...
Metanalysis re: psychosocial intervention for coc/amph use disorders - contingency management (CM) was "clear winner".
For meth use disorder - CM, CBT, and exercise demonstrated clear efficacy (seemingly less convincing re: transcranial stim).
Metanalysis re: psychosocial intervention for coc/amph use disorders - contingency management (CM) was "clear winner".For meth use disorder - CM, CBT, and exercise demonstrated clear efficacy (seemingly less convincing re: transcranial stim).
Kathleen Carroll (Yale), cont'd...
Where to head? Contingency management (CM) is best treatment. Sets "high bar" for pharmacotherapy for stim. use disorders that does better than CM.
Non-abstinence based measures - *reductions* in use correlate w/ psychosocial functioning.
Where to head? Contingency management (CM) is best treatment. Sets "high bar" for pharmacotherapy for stim. use disorders that does better than CM.Non-abstinence based measures - *reductions* in use correlate w/ psychosocial functioning.
Frances Levin (Columbia)...
Three pharmacotherapuetic frontrunners for stim. use disorders: topiramate, modafinil, & stimulants (not much evidence *does not mean not effective*).
Only 10 drugs (as of 2016) across non-human primates, human lab, and clinical treatment trial.
Three pharmacotherapuetic frontrunners for stim. use disorders: topiramate, modafinil, & stimulants (not much evidence *does not mean not effective*).Only 10 drugs (as of 2016) across non-human primates, human lab, and clinical treatment trial.
Frances Levin (Columbia), cont'd...
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.
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'd...
Intervention that first uses beh. therapy (CM) and then assesses outcome... if ineffective, add agonist-based therapy + reassess (more than just abstinence).
Extended-release amph + topiramate were most effective against severe coc. users.
Intervention that first uses beh. therapy (CM) and then assesses outcome... if ineffective, add agonist-based therapy + reassess (more than just abstinence).Extended-release amph + topiramate were most effective against severe coc. users.
Chang-Guo Zhan (U. Kentucky)...
Preclinical development of pharmacotherapies for stim. use disorders: small molecules, vaccines (active immunity), mAbs (passive immunity), metabolic enzyme approach (gene therapy).
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'd...
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.
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 #CPDD20 https://pubmed.ncbi.nlm.nih.gov/32189158/
From Chang-Guo Zhan (U. Kentucky). See more here
#CPDD20 https://pubmed.ncbi.nlm.nih.gov/32189158/
