Posted on ADHD

Does Getting ADHD Medication Through Telehealth Increase Addiction Risk?

Cognitive behavior therapy conducted by telephone may ease arthritis-related insomnia

Over the past few years, people with ADHD have had the convenient option of getting their stimulant medications prescribed via telehealth. However, with the rules that made this possible and set to expire soon, questions about the safety of virtual ADHD care are in the spotlight.

A new study from the University of Michigan, published in Health Affairs, sheds light on this issue. It reveals that individuals aged 12 to 64 who started their stimulant medication through telehealth were slightly more likely to develop a substance use disorder (SUD) within a year compared to those who started with in-person care. However, when accounting for pre-existing mental health conditions, such as depression, the increased risk largely disappeared—except for a specific age group.

Key Findings

The study found that the risk of developing SUD was 3.7% for those who started ADHD medication via telehealth versus 3.2% for those who started in-person. When mental health conditions were considered, the increased risk vanished for most age groups, except for adults aged 26 to 34. This group still showed a higher risk of SUD, which might be linked to their newfound independence in managing their medication without parental oversight.

Implications for Telehealth ADHD Care

The findings suggest the need for better screening and ongoing monitoring for addiction risk, especially for young adults. As Joanne Constantin, Ph.D., the study’s lead author, points out, screening for addiction risk and monitoring for signs of SUD should be included in future telehealth policies for ADHD care.

Current Telehealth Rules and ADHD Medication

Currently, federal telehealth rules allow behavioral health care without an in-person visit until December 31. To prescribe stimulants for ADHD, clinicians need to be licensed by the U.S. Drug Enforcement Agency and often check state prescription drug monitoring programs. However, there are no specific guidelines for screening for SUD risk at the start of treatment or ongoing monitoring for SUDs.

The Role of Telehealth Companies

In recent years, several companies have started offering standalone ADHD care entirely via telehealth, especially during the COVID-19 pandemic. Some of these companies have faced legal issues due to alleged lack of oversight of how stimulants are used.

Study Details

The study used anonymous health insurance records from people with private insurance or Medicaid coverage. It included 77,153 individuals who had not received ADHD stimulant medication or an SUD diagnosis in the past year and started on a stimulant in 2021. Over 21,000 of these patients started via a telehealth visit, while the rest began with in-person visits. The researchers accounted for differences in mental health conditions and other factors in their analysis.

Conclusion

Telehealth has proven to be an essential way to access care, but balancing access with safety remains crucial. This study highlights the importance of guidelines for providers about screening and follow-up to ensure safe and effective ADHD care.

As policies evolve, it’s vital to keep in mind the need for comprehensive screening and monitoring to protect all patients, especially young adults, from potential risks associated with telehealth-based ADHD care.

Posted on Pain Management

Unlocking Pain Relief: A Cannabis Compound Without Side Effects

8 in 10 cannabis users report combining marijuana with exercise, saying it boosts motivation and mood, eases pain

When it comes to managing chronic pain, opioids have long been the go-to option. While effective, they come with serious risks—addiction and potentially fatal overdoses. But what if there was a way to harness the pain-relieving properties of cannabis without any of the mind-altering side effects? That’s exactly what researchers at Washington University School of Medicine in St. Louis and Stanford University have been working on.

A Safer Alternative

Scientists have developed a novel compound that provides pain relief without affecting the brain, avoiding the potential for addiction. This custom-designed molecule is derived from the cannabis plant and shows promise as a non-addictive alternative to opioids. Their groundbreaking research, recently published in Nature, offers hope to the estimated 50 million Americans suffering from chronic pain.

How It Works

The compound targets pain-reducing receptors in the body without crossing into the brain, meaning it doesn’t produce the psychoactive effects associated with marijuana. “For years, my lab has focused on developing non-addictive treatments for chronic pain,” says Susruta Majumdar, PhD, the study’s senior author. The compound attaches to pain receptors but avoids the brain’s reward center, where addiction forms.

The Role of Cannabis

Cannabinoid molecules in cannabis bind to receptors in the brain and body, helping to relieve pain. However, the mind-altering effects of marijuana have made it a less viable option for pain relief. By designing a cannabinoid molecule that can’t enter the brain, researchers achieved pain relief without these side effects.

Testing in Mice

In mouse models of nerve-injury pain and migraine headaches, the modified compound effectively eliminated touch hypersensitivity—a proxy for pain. Unlike opioids, the compound did not lead to tolerance, maintaining its effectiveness over nine days of twice-daily treatments.

The Future of Pain Relief

The compound’s design is key to its success. By targeting a hidden pocket on the CB1 receptor, which opens briefly, the researchers minimized tolerance development. This innovative approach could lead to new, more effective pain treatments without the risks associated with opioids.

Looking Ahead

While more studies are needed, this research is a significant step toward safer, non-addictive pain relief options. The team plans to develop the compound into an oral drug for potential clinical trials.

This discovery not only brings us closer to a much-needed alternative to opioids but also highlights the incredible potential of cannabis-derived compounds in medicine. Keep an eye out for more groundbreaking research in the future!

Posted on Autism, Mental health, neurological conditions

Autism Life? – Should I Stay or Should I Go? The Brain’s Decision Switchboard Uncovered

Distinct cell types in MRN

Distinct cell types in MRN, inhibitory neurons (GABAergic; blue), excitatory neurons (glutamatergic VGluT2+; green), and serotoninergic neurons (orange), differentially control perseverative, exploratory and disengaged states. Credit Sainsbury Wellcome Centre

Ever wondered how your brain decides whether to stick with a goal, try something new, or just give up? Scientists at the Sainsbury Wellcome Centre have made a groundbreaking discovery in understanding this process. By studying mice, they have uncovered neural circuits in the brainstem that control these crucial behavioral strategies. This research could provide insights into a variety of neuropsychiatric conditions, such as OCD, autism, and major depressive disorder.

The Brain’s Balancing Act

Our brains are constantly balancing different behavioral states. Whether we’re persevering in a task, exploring new options, or disengaging completely, this balance is essential for survival. However, in conditions like OCD and major depressive disorder, this balance is often disrupted.

Key Findings in Neural Circuits

The researchers focused on a midbrain area called the median raphe nucleus (MRN). They discovered three types of neurons in the MRN, each with a unique role in controlling behavior:

  1. GABAergic Neurons: Suppressing these neurons causes perseverance in a current goal.
  2. Glutamatergic Neurons: Activating these neurons drives exploration of new options.
  3. Serotonergic Neurons: Suppression of these neurons leads to disengagement.

How the Study Was Conducted

The team used a combination of naturalistic tasks, where mice acted on instinct, and learned tasks, where mice used prior knowledge of food rewards. They employed techniques like optogenetic manipulations, calcium imaging, and neural circuit tracing to reveal the functions of these neurons.

Real-World Implications

Understanding these neural circuits could help us better comprehend and treat neuropsychiatric conditions. For instance, an excessive drive to persist in familiar actions is seen in OCD and autism, while a lack of motivation is a symptom of major depressive disorder. Changes in the activity of specific neurons in the MRN might contribute to these conditions.

Future Directions

The researchers also found that the MRN receives positive or negative feedback from other brain regions, influencing decisions to persevere or disengage. This discovery positions the MRN as a central switchboard for decision-making, capable of flexibly controlling behavioral strategies.

Hope for Better Treatments

These insights could pave the way for more targeted treatments for mental disorders. For example, very low activity of serotonergic neurons in the MRN might contribute to depression. Understanding these mechanisms could lead to more effective and specific therapies, particularly for conditions linked to the neurotransmitter serotonin.

This discovery is not just a leap forward in neuroscience; it offers hope for better understanding and treating mental health conditions. So, next time you’re deciding whether to stick with something, explore new options, or give up, remember there’s a whole neural orchestra at work in your brain, playing the tune of your choices.

Feel free to share this fascinating find with your friends and family on social media or through your favorite messaging apps!

Posted on ADHD, Pain Management

High Rates of Prescription Drug Misuse Among Adults with Disabilities

Pills

People with disabilities that include difficulty with cognition or caring for themselves are at greater risk of misusing prescription painkillers, tranquilizers and stimulants, a WVU study shows. Credit (WVU Photo/Jake Stump)

A recent study conducted by West Virginia University has revealed a concerning trend: Adults with disabilities are nearly twice as likely to misuse prescription drugs compared to adults without disabilities. The research, led by Jeanette Garcia, an associate professor at the WVU College of Applied Human Sciences, highlights the pressing need to address prescription drug misuse in this vulnerable population.

The study analyzed data from the 2021 National Survey on Drug Use and Health, encompassing responses from 47,100 adults, of whom approximately 10.9% reported having at least one disability. These disabilities ranged from difficulties with vision, hearing, movement, cognition, self-care, to communication. The findings, published in the American Journal of Preventive Medicine, showed that nearly 10% of individuals with disabilities reported misusing prescription drugs within the past year, compared to just 4.4% of individuals without disabilities.

Garcia emphasized the urgency of these findings, stating, “We saw the highest rates of drug misuse among adults with cognitive disabilities and young adults, with pain relievers being the most misused drugs.”

The researchers tracked the misuse of prescription stimulants (e.g., amphetamines), tranquilizers (e.g., benzodiazepines), and pain relievers (e.g., opioids), all of which have high addictive properties and potentially dangerous side effects. The results were clear: adults with disabilities, especially those younger than 30, had significantly higher rates of misuse across all three drug categories.

The study underscores the importance of early prevention efforts, particularly for adolescents and young adults with disabilities. Garcia noted that adolescents with cognitive difficulties are particularly vulnerable to prescription drug misuse, which can exacerbate cognitive impairment as they transition into adulthood.

Individuals with disabilities are more likely to experience risk factors for prescription drug misuse, such as chronic pain, heightened anxiety, major depression, and poor physical health. They are also more likely to receive prescription medications but less likely to receive adequate counseling on the dangers of misuse. Communication barriers and the challenge of finding specialists who understand their complex health conditions further exacerbate the issue.

JeanetteGarcia

Jeanette Garcia, associate professor, WVU College of Applied Human Sciences  Credit(WVU Photo)

For every category of prescription drug examined—stimulants like Adderall, tranquilizers like Xanax, and pain relievers like Oxycontin—misuse was highest among those with cognitive and self-care disabilities. The most alarming statistic was a 27% misuse rate of pain relievers among adults aged 30-49 with cognitive disabilities.

Garcia explained that cognitive and self-care difficulties often indicate chronic conditions like traumatic brain injuries, which increase the risk of painkiller misuse due to chronic pain and limited impulse control. Additionally, individuals with cognitive disabilities frequently suffer from sleep issues and mental health disorders, such as anxiety and depression, which are linked to tranquilizer abuse. ADHD, characterized by poor concentration and lack of self-care, is correlated with stimulant misuse.

While misuse rates for stimulants and tranquilizers were similar for young adults with and without disabilities, a stark difference emerged regarding pain relievers. Older adults with disabilities had significantly higher rates of pain reliever misuse compared to their non-disabled counterparts. Garcia speculated that this could be due to chronic pain from disabilities worsening with age and higher rates of physician-prescribed pain medications for older adults.

Given the marked increase in pain reliever misuse among adults with disabilities across all age groups, Garcia believes medical providers should consider alternative pain treatments. “Physicians and policymakers need to be aware of the high rates of prescription drug misuse we’re seeing, especially among adults with cognitive and self-care difficulties,” she said. “An important next step will be exploring the extent to which the severity of someone’s disability or the presence of an additional condition like anxiety affects the likelihood of misuse.”

This research is a crucial step in understanding and addressing the complex issue of prescription drug misuse among adults with disabilities, paving the way for targeted interventions and improved healthcare practices.

Posted on Arthritis, Diabetes, Multiple Sclerosis, Sleep disorders

“Good Night, Strong Steps: Sleep Health Crucial for Mobility in Women with MS”

Hold on to your pillows, because it turns out that catching those precious Z’s might be even more important than we thought—especially for women dealing with multiple sclerosis (MS) and other chronic conditions!

According to new research from the University of Michigan Health, poor sleep health could be a sneaky culprit behind declining mobility in older women. Published in Sleep Epidemiology, the study focused on women with chronic conditions like diabetes, osteoarthritis, and Multiple Sclerosis. It found that those with symptoms of obstructive sleep apnea (a common sleep disorder) were more likely to experience mobility issues down the road.

“Sleep troubles often get brushed off as just part of aging or chronic illness,” says Dr. Tiffany J. Braley, associate professor of neurology and director of the multiple sclerosis and neuroimmunology division at the University of Michigan Health. But guess what? These sleep woes might be causing mobility problems, not just tagging along for the ride.

Dr. Daniel Whibley, assistant professor of physical medicine and rehabilitation, adds that treating sleep issues can improve daily movement. “Our clinical experience shows that how well someone sleeps can directly impact their ability to stay active and manage their condition,” he says.

The study found that women with signs of obstructive sleep apnea, poor sleep durations, and a sense of inadequate sleep were more likely to need mobility aids like canes or wheelchairs in the future. But there’s a silver lining: identifying and treating sleep problems early on could help prevent these issues.

So, if you’re dealing with a chronic condition like MS, don’t snooze on your sleep health! Speaking up about sleep troubles and seeking help from a specialist could make a world of difference in staying mobile and active.

Sweet dreams, and may they lead to a brighter, more mobile future!