Addiction Research Sheds Light on Alcohol, Opiods, and Zombie Drugs

by Denis Storey
May 6, 2024 at 12:21 PM UTC

Despite progress, addiction remains a persistent challenge for caregivers, whether its alcohol, opioids, or the rise of zombie drugs.

Clinical relevance: Addiction presents a persistent challenge despite progress, showcasing shifts in alcohol consumption and the evolution of the opioid epidemic.

  • Research suggests potential novel treatments for alcohol use disorder (AUD) using glucagon-like peptide-1 receptor agonists (GLP-1RAs) like semaglutide.
  • Analysis of opioid use disorder (OUD) management trends reveals a drop in emergency department (ED) visits despite increased fatalities, emphasizing the need for improved screening and expanded access to medications like buprenorphine and naloxone.
  • A case study illustrates the dangers of xylazine, an emerging adulterant in street drugs, masking benzodiazepine withdrawal symptoms and emphasizing the importance of monitoring and testing strategies in addiction management.

Addiction remains a Sisyphean task for mental health professionals: No matter how much progress we make, the problem persists.

It migrates, as we’ve witnessed with alcohol. The National Institutes of Health reports that over the past decade, those between 19 and 30 have largely turned away from the bottle in terms of past-month use, daily drinking, and binge drinking. While those between 35 and 55 have embraced it, hitting record-high levels of binge drinking in 2022.

It mutates, which the opioid epidemic has shown us over the last 30 years. According to the CDC, opioid addiction flooded the country in at least three waves.

  • The first began with the 1990s spike in prescriptions.
  • It evolved – or devolved – in 2010 when heroin overdose deaths started spreading.
  • Finally, 2013 witnessed a wave of overdose deaths driven by synthetic opioids, including fentanyl.

And it metastasizes. How else to explain the rise of tranqs – dubbed zombie drugs – making their way into common street corner products?

Both The Journal of Clinical Psychiatry and The Primary Care Companion for CNS Disorders regularly publish research that helps mental health professionals stay ahead of addiction. This week, we’re presenting summaries of three addiction studies – and links – for further review.

Semaglutide Weight Loss Therapy Appears to Ease Alcohol Use Disorder Symptoms

While historical approaches to alcohol use disorder (AUD) treatment have focused more on behavioral therapies and a few FDA-approved medications, more recent interest has turned to glucagon-like peptide-1 receptor agonists (GLP-1RAs) as a potential pharmacological intervention.

GLP-1RAs, initially developed for type 2 diabetes and approved for weight loss, have shown promise in preclinical studies for treating substance use disorders, including AUD.

In November 2023, JCP published a case series that explores the benefits of one such GLP-1RA, semaglutide, on AUD in half a dozen patients undergoing weight loss treatment.

All six patients showed notable drops in their AUDIT scores, indicating a drop-off in alcohol consumption. The study’s authors emphasized the importance of these results since the semaglutide therapy wasn’t meant to address alcohol use. And the study included no other formal behavioral interventions for AUD.

The cases in this study varied in demographics, comorbidities, and initial AUDIT scores. But they all showed notable improvements in AUDIT scores. The authors added that the scores improved even without a drop in weight, insisting that the AUD benefits could be unrelated.

While the study offers promising results, the authors acknowledge some limitations to their research. The authors point to the retrospective nature of the analysis and potential confounding variables.

Additionally, because of the variable follow-up times between intake and follow-up assessments, the researchers suggest additional studies to better determine the long-term efficacy of semaglutide in AUD treatment.

The findings hint at the potential of GLP-1RAs as a novel AUD treatment approach. The researchers argue that future analysis, including randomized controlled trials, should confirm these preliminary findings and explain the underlying mechanics. If replicated, GLP-1RAs could represent a major advancement in the pharmacological management of AUD.

Analysis Reveals Emerging Trends in Opioid Addiction

Emergency departments (EDs) have emerged as the front-line defense for addressing acute opioid use disorder (OUD) and associated overdoses. And while the administration of OUD medication in EDs has shown promise as an effective treatment, an information gap remains.

To address this, a group of researchers conducted a secondary analysis of National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2016 to 2021. The team looked at trends in OUD and associated ED visits, prescription patterns of buprenorphine and naloxone, and the socio-demographic features and clinical outcomes of OUD patients.

The review showed a drop in ED visits for OUD, despite an overall increase in fatalities. The researchers attribute this disparity to several factors, including the lingering after-effects of the pandemic on healthcare delivery and OUD screening challenges.

The researchers noted a jump in ED buprenorphine therapy during the study period, highlighting a positive trend in OUD management, but naloxone distribution after discharge remained challenging.

Demographic trends in OUD presentations appeared to be consistent with existing literature, with most patients being younger men from urban settings.

The numbers, the authors insist, underscore an urgent need for better OUD screening and diagnosis in EDs, along with expanded access to buprenorphine treatment and naloxone distribution, to address the ongoing opioid crisis more effectively.

Case Study Reveals How Xylazine Masks Benzodiazepine Withdrawal

Xylazine, a potent veterinary anesthetic, has emerged as a dangerous – and increasingly common – adulterant in street drugs in recent years.

This final case study, appearing in PCC, discusses a 35-year-old man with a history of polysubstance use who experienced a withdrawal seizure likely masked by xylazine. Despite reporting benzodiazepine withdrawal symptoms, the patient’s bradycardia and lack of overt symptoms led caregivers to decide against immediate treatment.

He then suffered a seizure, which the authors blamed on the masking effect of xylazine on benzodiazepine withdrawal symptoms. Subsequent tests revealed the presence of various impurities, including xylazine, in the patient’s drug supply.

Xylazine, acting as an alpha-2 adrenergic agonist, produces sedation and muscle relaxation, potentially concealing the physiological signs of benzodiazepine withdrawal without providing the necessary GABAergic effects to prevent seizures.

The authors emphasize the importance of monitoring addiction patients with polysubstance use closely and remaining vigilant for withdrawal symptoms. Additionally, they stress the value of drug testing to identify impurities and additives, which helps both patients and their providers to see what’s in these street drugs.

Finally, this case illustrates the lethal impact of xylazine and the need for comprehensive monitoring and testing strategies to address the risks associated with adulterated street drugs. It also serves as a stark reminder of the complex interplay between different substances in polysubstance use disorders and the clinical management challenges they present.

Further Reading:

Why Aren’t Buprenorphine Prescriptions Taking Off?

Drug Overdose Deaths Reach Pandemic Levels

Homelessness Drives Overdose Deaths

Commentary

The Long Road Toward Equitable MDMA Treatment in the United States

Kozak and Aaronson discuss challenges in implementation of MDMA-assisted therapy, including insurance and Medicare coverage as well as cultural barriers.

Zofia Kozak and others

Strategies for Cutting Down and Stopping Alcohol Use

Knowledge of nonpharmacologic approaches as well as medications’ mechanisms of action, side effects, and drug-drug interactions can facilitate the timely and appropriate use of psychotropics to help individuals cut down or stop their use of alcohol.

Sofia E. Matta and others