Addiction Medicine

Buprenorphine Maintenance Therapy in Opioid-Addicted Health Care Professionals Returning to Clinical Practice: A Hidden Controversy

by Ethan Bryson

Hamza H, Bryson EO.
Mayo Clinic Proceedings, March 2012

It remains controversial whether it is safe for recovering health care professionals to return to clinical practice... more It remains controversial whether it is safe for recovering health care professionals to return to clinical practice after treatment for drug addiction. One specific component of reentry that remains particularly contentious is the use of pharmacotherapeutics, specifically buprenorphine, as opioid substitution therapy for health care professionals who wish to return to clinical work. Because health care professionals are typically engaged in safety-sensitive work with considerable consequences when errors occur, abstinence-based recovery should be recommended until studies demonstrate that it is safe to allow this population to practice while undergoing opioid substitution therapy.

Cannabinoid receptor stimulation increases motivation for nicotine and nicotine seeking.

by Islam Gamaleddin

The cannabinoid system appears to play a critical facilitative role in mediating the reinforcing effects of nicotine... more The cannabinoid system appears to play a critical facilitative role in mediating the reinforcing effects of nicotine and relapse to nicotine-seeking behaviour in abstinent subjects based on the actions of cannabinoid (CB) receptor antagonists. However, the effects of CB receptor stimulation on nicotine self-administration and reinstatement have not been systematically studied. Here, we studied the effects of WIN 55,212-2, a CB1/2 agonist, on intravenous nicotine self-administration under fixed-ratio (FR) and progressive-ratio (PR) schedules of reinforcement in rats. The effects of WIN 55,212-2 on responding for food under similar schedules were also studied. In addition, the effects of WIN 55,212-2 on nicotine- and cue-induced reinstatement of nicotine seeking were also studied, as well as the effects of WIN 55,212-2 on nicotine discrimination. WIN 55,212-2 decreased nicotine self-administration under the FR schedule. However, co-administration of WIN 55,212-2 with nicotine decreased responding for food, which suggests that this effect was non-selective. In contrast, WIN 55,212-2 increased both nicotine self-administration and responding for food under the PR schedule, produced dose-dependent reinstatement of nicotine seeking, and enhanced the reinstatement effects of nicotine-associated cues. Some of these effects were reversed by the CB1 antagonist rimonabant, but not by the CB2 antagonist AM630. In the drug discrimination tests between saline and 0.4 mg/kg nicotine, WIN 55,212-2 produced no nicotine-like discriminative effects but significantly potentiated discriminative stimulus effects of nicotine at the low dose through a CB1-receptor-dependent mechanism. These findings indicate that cannabinoid CB1-receptor stimulation increases the reinforcing effects of nicotine and precipitates relapse to nicotine-seeking behaviour in abstinent subjects. Thus, modulating CB1-receptor signalling might have therapeutic value for treating nicotine dependence

Inhibition of anandamide hydrolysis by cyclohexyl carbamic acid 3′-carbamoyl-3-yl ester (URB597) reverses abuse-related behavioral and neurochemical effects of …

by Islam Gamaleddin

Evidence for Habitual and Goal-Directed Behavior Following Devaluation of Cocaine: A Multifaceted Interpretation of Relapse

by David Barker

Evidence for learned skill during cocaine self-administration in rats.

by David Barker

RATIONALE:
It has been proposed that cocaine abuse results in skilled or "automatic" drug-taking... more RATIONALE:
It has been proposed that cocaine abuse results in skilled or "automatic" drug-taking behaviors. Brain regions important for skill learning are implicated in cocaine self-administration. However, the development of skill during self-administration has not been investigated.

OBJECTIVES:
The present experiment investigated the development of skilled self-administration over extended drug use by employing a novel operant vertical head movement under discriminative stimulus (S(D)) control. In addition, the capacity of the head movement to serve as an operant was tested by manipulating drug levels above or below satiety drug levels via frequent noncontingent microinfusions (0.2 s) of cocaine.

RESULTS:
Animals acquired the vertical head movement operant, which increased in number over days. Task learning was demonstrated by reduced reaction time in response to the S(D), increased propensity to self-administer upon S(D) presentation, and escalated drug consumption over days. Skill learning was demonstrated by (1) an increase over days in the velocity of operant movements, as a function of shorter duration but not altered distance, and (2) an increase over days in the probability of initiating the operant at the optimal starting position. Evidence that responding was specific to self-administration was revealed during periods of experimenter-manipulated drug level: maintaining drug levels above satiety decreased responding while maintaining drug levels below satiety increased responding.

CONCLUSIONS:
Under the specific set of circumstances tested herein, cocaine self-administration became skilled over extended drug use. The vertical head movement can be used as an operant comparable to lever pressing with the additional benefit of quantifying skill learning.

Understanding Problematic Drug Use: A Medical Matter or a Social Issue?

by Julian Buchanan

Buchanan, J. (2006) 'Understanding Problematic Drug Use: A Medical Matter or a Social Issue ?'. British Journal of Community Justice, 4, (2) 387–397

his paper questions the notion that problem drug use is essentially a physiological medical problem that requires... more his paper questions the notion that problem drug use is essentially a physiological medical problem that requires coercive treatment, from which success are measured by way of drug testing to determine the abstinence from the drug. The article argues that the causes and solutions to problem drug use are much more to do with socio-economic factors than physiological or psychological factors. In particular it explores the connections between the emergence and sudden rise in problematic drug use that occurred across the UK in the mid 1980s, with de-industrialisation and the decline of opportunities for unskilled non academic young people. Further the paper critically examines the notion of the ‘problem drug user’, in particular how those identified and labelled, are perceived and treated by wider society, and how this adversely impacts upon drug rehabilitation and social integration.

Post-Soviet Placebos: Epistemology and Authority In Russian Treatments for Alcoholism

by Eugene Raikhel

The dominant modalities of treatment for alcoholism in Russia are suggestion-based methods developed by narcology—the... more The dominant modalities of treatment for alcoholism in Russia are suggestion-based methods developed by narcology—the subspecialty of Russian psychiatry which deals with addiction. A particularly popular method is the use of disulfiram—an alcohol antagonist—for which narcologists commonly substitute neutral substances. Drawing on 14 months of fieldwork at narcological clinics in St. Petersburg, this article examines the epistemological and institutional conditions which facilitate this practice of “placebo therapy.” I argue that narcologists’ embrace of such treatments has been shaped by a clinical style of reasoning specific to a Soviet and post-Soviet psychiatry, itself the product of contested Soviet politics over the knowledge of the mind and brain. This style of reasoning has facilitated narcologists’ understanding of disulfiram as a behavioral, rather than a pharmacological, treatment and has disposed them to amplify patients’ responses through attention to the performative aspects of the clinical encounter and through management of the treatment’s broader reputation as an effective therapy. Moreover, such therapies have generally depended upon, and helped to reinforce, clinical encounters premised on a steeply hierarchical physician–patient relationship.

Eugene Raikhel. "Institutional Encounters: Identification and Anonymity in Russian Addiction Treatment (and Ethnography)." In Being There: The Fieldwork Encounter and the Making of Truth, John Borneman and Abdellah Hammoudi eds. University of California Press, 2009.

by Eugene Raikhel

The anesthetic implications of illicit opioid abuse

by Ethan Bryson

Bryson EO.
International Anesthesiology Clinics, Winter 2011

Propofol Abuse

by Ethan Bryson

Bryson EO, Frost EAM.
International Anesthesiology Clinics, Winter 2011

The drug seeking anesthesia care provider

by Ethan Bryson

Bryson EO, Hamza H.
International Anesthesiology Clinics, Winter 2011

One approach to the return to residency for anesthesia residents recovering from opioid addiction

by Ethan Bryson

Journal of Clinical Anesthesia (2008) 20, 397–400

Addiction and Substance Abuse in Anesthesiology

by Ethan Bryson

Anesthesiology (2008) 109:905–17

Intranasal Self-Administration of Remifentanil As the Foray Into Opioid Abuse by An Anesthesia Resident

by Ethan Bryson

Anesthesia and Analgesia (2010) Feb 1;110(2):524-5

Should Anesthesia Residents With a History of Substance Abuse Be Allowed to Continue Training In Clinical Anesthesia? The Results of a Survey of Anesthesia Residency …

by Ethan Bryson

Juornal of Clinical Anesthesia (2009) Nov;21(7):508-13

Anesthesia for patients on buprenorphine

by Ethan Bryson

Bryson EO, Lipson S, Gevirtz C.
Anesthesiology Clinics of North America, December 2010

Is a 5-Year Follow-Up for Addicted Attendings Who Entered a Physicians Health Program Valuable Information?

by Ethan Bryson

Anesthesia and Analgesia (2010) Apr 1;110(4):1244-5