Thursday, January 19, 2023

DECRIMINALIZE DRUGS

Availability of recreational cannabis reduced demand for prescription codeine

Peer-Reviewed Publication

UNIVERSITY OF PITTSBURGH

States that permit recreational use of cannabis see a reduction in demand for prescription codeine, an opioid with a high potential for misuse, according to a new multi-institutional study led by University of Pittsburgh and Cornell University scientists.

Published this week in Health Economics, the study finds a significant reduction in pharmacy-based codeine distribution in states that have legalized recreational cannabis use. The finding is promising from a public health policy perspective because misuse of prescription opioids annually contributes to more than 10,000 overdose deaths.

Twenty-one U.S. states have passed recreational cannabis laws and legislatures in other states are considering similar measures.

“A reduction in the misuse of opioids can save lives,” said lead author Shyam Raman, a doctoral candidate in Cornell’s Jeb E. Brooks School of Public Policy. “Our research indicates that recreational cannabis laws substantially reduce distribution of codeine to pharmacies, an overlooked potential benefit to legalizing recreational cannabis use.”

The study is among the first to separately examine the impact of recreational cannabis laws on shipments of opioids to hospitals, pharmacies and other endpoint distributors. Previous studies have focused on medical cannabis laws or use of opioids by subsets of consumers, such as Medicaid beneficiaries.

The researchers analyzed data from the Drug Enforcement Administration’s Automation of Reports and Consolidation Orders System (ARCOS) which tracks the flow of controlled substances in the U.S. These are their key findings from states that passed recreational cannabis laws:

  • A reduction of 26% in pharmacy-based distribution of codeine and as much as a 37% reduction after recreational cannabis laws have been in effect for four years.
  • Minimal impact on distribution of other opioids such as oxycodone, hydrocodone and morphine in any setting.
  • Minimal impact on codeine distribution by hospitals which are often have less permissive policies than pharmacies.

“This finding is particularly meaningful,” said senior author Coleman Drake, Ph.D., assistant professor of health policy and management at Pitt’s School of Public Health. “Among prescription opioids, codeine misuse is especially high. Our findings suggest recreational cannabis use may be a substitute for codeine misuse.”

While cannabis and opioids can be used to minimize chronic pain symptoms, they aren’t equivalent in their impact on health.  

“Increasing legal access to cannabis may shift some consumers away from opioids and towards cannabis,” said Johanna Catherine Maclean, Ph.D., of George Mason University. “While all substances have some risks, cannabis use is arguably less harmful to health than the non-medical use of prescription opioids.”

W. David Bradford, Ph.D., of the University of Georgia, is an additional co-author of this research, which was supported by the National Institute on Drug Abuse of the National Institutes of Health under award K01D1051761. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

 


Heavy drinking in young adults tied to endocannabinoid pathway

Peer-Reviewed Publication

ELSEVIER

Heavy drinking in young adults tied to endocannabinoid pathway 

IMAGE: [11C]CURB BINDING, REFLECTING BRAIN LEVELS OF FAAH, RELATES TO SELF-REPORTED ALCOHOL OUTCOMES. THE AUDIT MEASURES RISKY OR HAZARDOUS ALCOHOL USE, WHILE THE ASQ (ALCOHOL SENSITIVITY QUESTIONNAIRE) MEASURES THE EFFECTS OF ALCOHOL, WITH HIGHER SCORES INDICATING LOWER SENSITIVITY TO ALCOHOL’S EFFECTS. view more 

CREDIT: BIOLOGICAL PSYCHIATRY

Philadelphia, January 18, 2023 – Although heavy drinking in young adulthood increases the risk for alcohol use disorder (AUD), not all young heavy drinkers go on to develop AUD, globally the most common substance use disorder. Research has shown that individual differences in alcohol sensitivity and cardiovascular responses may predict drinking patterns and progression to AUD. Little is known, however, about the brain-based mechanisms of AUD vulnerability – a better understanding of which could guide preventive interventions against AUD. A new study explores the role of endocannabinoid levels in hazardous alcohol use.

The study appears in Biological Psychiatry, published by Elsevier.

Led by Isabelle Boileau, PhD, at the Centre for Addiction and Mental Health and University of Toronto, the new study explores the relationship between fatty acid amide hydrolase (FAAH) levels in heavy drinking youth and alcohol intake, drinking patterns, differential responses to alcohol, and family history of AUD. The researchers hypothesized that lower brain FAAH levels would correlate to heavier and more hazardous drinking.

FAAH is an enzyme that degrades the endogenous cannabis-like substance anandamide, a neurotransmitter that activates the cannabinoid 1 receptor (CB1) and is involved in the regulation of pain, appetite, and mood. Endocannabinoid activity specifically in the brain’s striatum and prefrontal cortex regions is thought to modulate the rewarding effects of alcohol. Studies in animals and people have suggested that reduced FAAH activity leads to increased alcohol seeking and consumption and decreased negative effects of intoxication.

The researchers used positron emission tomography imaging of [11C]CURB, a highly specific radiotracer for FAAH, to assess FAAH levels in the striatum, prefrontal cortex, and whole brains of 31 participants aged 19 to 25 who reported at least one occurrence of heavy drinking in the previous 30 days. The researchers also measured behavioral and cardiovascular responses while administering controlled intravenous alcohol infusions to participants.

Lower [11C]CURB binding, reflecting lower FAAH activity and presumably higher anandamide levels, was not related to frequency of alcohol use, but it was associated with more severe use, a greater reported craving for alcohol prior to the infusion, a greater reported “liking” of intoxication during the infusion, and reduced sensitivity to the negative effects of alcohol. “In our study, young adults with lower brain levels of FAAH reported greater stimulation and fewer intoxicating and sedating effects from drinking alcohol,” said Dr. Boileau.

Lower FAAH levels were also associated with lower heart-rate variability, a cardiac measure of parasympathetic nervous system activity. A family history of AUD, present in about half the participants, had no relationship to [11C]CURB binding.

“Our findings are important as they suggest that FAAH levels in the brain may contribute to the maintenance of excessive drinking and to susceptibility for developing an AUD and provide a brain-based target for prevention efforts and treatment approaches,” Dr. Boileau added.

John Krystal, MD, editor of Biological Psychiatry, said of the work, “This fascinating study provides evidence linking increased endocannabinoid levels to reduced sensitivity to the negative effects of alcohol, an important risk factor for heavy drinking and AUD.”

This work suggests that FAAH levels may influence a youth’s susceptibility to alcohol misuse. These findings may guide researchers toward preventive measures to avoid AUD during this critical developmental stage, or potentially to interventions for treatment of AUD. 

 


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