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BOOMING PROBLEM Elderly Subtance Abuse Issues Expected To Grow as Baby Boomers Age TRACKERS RELAPSE

BORN WITH IT Scientists Discover Possible 'Meth Gene’

Researchers have recently identified a gene that may play a role in meth addiction. New findings by Boston University School of Medicine researchers, published in PLOS Genetics, spotlight a gene called heterogeneous nuclear ribonucleoprotein H1 (Hn- rnph1). The research uncovered a link between this gene and how it effects behavior when stimulants are introduced. This new insight can help scientists understand genetic risk factors for addiction, along with some neuropsychiatric disorders. Also, this new understanding about how Hnrnph1 works could lead to the development of a prescription drug to help treat meth ad- diction, researchers say.

Need To Ident i fy Targets

other findings to improve the treatment of both dopamine- related problems like attention- deficit hyperactivity disorder, schizophrenia, and bipolar disor- der, along with dopaminerelated neurodegenerative disorders like Parkinson’s or Huntington’s diseases. Scientists say the genetic epide- miology of meth use disorders is very complex. Efforts to under- stand the biological processes that increase susceptibility to meth use disorders (i.e., abuse, dependence and psychosis) have uncovered several genetic variants. However, more research needs to be done. Though gene research can led to breakthroughs in treatment, Boston University points out in its news release that genetics alone are not responsible for addiction. Environmental and social factors also play an im- portant role.

The BU scientists discovered that Hnrnph1 “codes” for an RNA protein that regulates how other genes are processed in the brain. To better understand the genetic basis of meth addiction, the next step is to figure out the exact genetic targets of Hnrnph1. “A better understanding of the brain region and cell type-specific binding targets of Hnrnph1 will tell us more about the function of this gene and possibly identify new therapeutic strategies for minimizing risk and treating psycho-stimulant addiction — a disorder for which there is currently no FDA-approved drug,” says study co-author Dr. Camron Bryant in a news release from Boston University.

The study could also lead to

Other factors in addict ion According to the National Institute on Drug Abuse (NIDA), these are some of the environmental factors that come into play with ad- diction: • Friends and people addicts spend time with • Age when a person begins using drugs or alcohol • Neighborhood

“A better understanding

of the brain region and

cell typespecific binding

targets of Hnrnph 1 will

tell us more about the

function of this gene.” — Dr. Camron Bryant, study co-author

• Availability of drugs and alcohol • Presence of mental health issues • Gender

These environmental influences interact with genetic factors to influ- ence an individual’s susceptibility to addiction. While scientists hope to better understand the role genetics plays in addiction to meth and other drugs, much more research needs to be done to solve the puzzle.

Genetics alone are not responsible for addiction. Environmental and social factors also play an important role.

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"Not only are the recommendations comprehensive they were developed with input from a wide range of stake- holders, and wherever possible draw from evidence-based research:'

SENSEOF URGENCY

“This is a complex epidemic with no simple solutions.” —Dr. G. Caleb Alexander, co-director of the Johns Hop- kins Center for Drug Safety and

“There’s a lot of information that can be gained from when somebody relapses.” - Dr. Stephanie Carreiro, University of Massachusetts

Fitness trackers could help prevent relapses

Dr. Carreiro says wearable biosensors can detect a relapse event for some substances (like heroin and cocaine) by sensing a change in heart rate or other physical conditions. The treatment provider can then use the fitness tracker ’s other information, like the time and location of the relapse event, to develop a profile about the conditions that prompt a patient to use. “It gives us very specific contextual information and serves as that reminder to the patient that someone could potentially know right away when they relapse,” Dr. Carreiro says.

Fitness trackers, or wearable biosensors, like Fitbit and Jawbone are the latest fitness trend to gain widespread popularity. But some believe they could be used to treat addiction as well. New research suggests the devices can be used to reliably detect relapses, which could then give treatment providers the information they need to prevent relapses in the future. “There’ s a lot of information that can be gained from when somebody relapses,” says Dr. Stephanie Carreiro, a researcher from the University of Massachusetts.

ACCOUNTABILITY MATTERS That accountability to someone who could see the relapse is an important step in moving past simple self-reporting and drug testing. People can lie during self-reports and drug testing will only show that drugs were used, but not information like how much was used, when it was used, and where. Because the sensors can be easily removed, the system will only work for patients who are truly motivat- ed to stay sober. Dr . Carreiro says rather than a big brother scenario with treatment providers tracking a patient’s movements, the devices simply connect a patient to their support network. “We could potentially trigger an interaction with a patient just seeing if they’re okay and need some help,” Dr. Carreiro says.

“It definitely served as a reminder that there was something motivating them to stay sober.”

- Dr. Stephanie Carreiro

SIMPLE REMINDER In a study of 15 patients, nearly everyone kept wearing the devices even when relapsing. D r. Car- reiro says that’s because many people are already used to wearing fitness trackers, and the treatment plan simply fits into the daily routines they’ve al - ready established. Researchers also say just having a physical object on a patient ’s wrist to remind them about their dedication to sobriety can be enough to prevent a relapse. “Multiple people looked at it and thought of going back to jail or being there for their children,” D r. Carreiro says. “It definitely served as a reminder that there was something motivating them to stay sobe r.”

WHAT ABOUT PREVENTION? The ultimate goal is to prevent relapses and keep patients on the path to sobriety. While the tech- nology is advancing quickl y, researchers say the collective knowledge base simply isn ’t there yet to predict a relapse event. But as they conduct more studies and develop better algorithms with the information gained, they should be able to tailor interventions to a specific patient and hopefully keep them from relapsing. “We need to continue to define different pro - files so that we can get a more complete under - standing of what ’ s happening,” D r. Carreiro says. “That’s when it will be the most powerful.”

“Everythingwe knowabout older adults and substance abuse probably doesn’t apply to Baby Boomers.” - Dr. Alexis Kuerbis, CUNY - Hunter College

overall numbers present a problem. “We’re grossly understaffed in being able to handle these problems,” says Dr. Dan Blazer, a psychiatrist at Duke University who has studied the issue extensive­ ly. “It’s a problem. I think it’s a problem that’s going to get larger as time goes on and we’re probably already seeing evidence of that.” But there’s also an issue of attitude. Baby Boomers, in general, have a more relaxed view of substance use, and experts fear they may carry those behaviors later into life. “There’s no evidence that they’re going to automati­ cally stop when they hit 65 years old,” Dr. Blazer says. “They’ve used them all their life, they say, ‘Why shouldn’t I use them now?’”

Even though elderly people show substance abuse issues in a much lower percentage than other age groups, the problem is more prevalent than many realize. And it appears it’s only going to get worse. Studies vary, but generally show between 2.2 and 9 percent of older adults have an alcohol use disor­ der, and experts say they’re already seeing a rise in marijuana and opioid abuse issues. With the large population of Baby Boomers aging, substance abuse numbers in the elderly population are expected to continue to rise, presenting serious problems for treat­ ment providers and family members. Researchers say the problem is twofold: part is sheer numbers, the other is attitude. With the number of older adults in the U.S. expected to increase from 40.3 million to 72.1 million between 2010 and 2030,

HIDDEN DANGERS

Experts say the lifestyle of elderly people presents a unique challenge for physicians and treatment providers. For example, because retired people don’t work, substance use doesn’t present a problem at their jobs, a typical red flag for younger people. Experts also say too often doctors fall victim to their own prejudices and don’t ask the right questions that could lead to a diagnosis.

Although success rates in treat­ ment can be better for older adults, the way they’re treated isn’t necessarily the same. Dr. Sacco says older adults respond better to more collaborative treat­ ment programs that give them options. “For so long it was trying to fit older adults into these programs, but now it might be chang­ ing these programs to fit older adults,” Dr. Sacco says.

“People think this person doesn’t look like a substance user,” says Dr. Paul Sacco, an expert on substance abuse in older adults. “Sometimes physical problems associated with alcohol abuse are assumed to have a different cause in older adults.” Substance abuse can be even risk­ ier for older adults as their bodies become less resistant to the stress­ es brought on by substance use.

PLANNING AHEAD

To mitigate the expected problems as much as possi­ ble, experts say we need to train more counselors and physicians on how to best treat older adults, and how to spot potential problems in the first place. “With just a little bit of education about older adults, I think you could make a very big impact,” says Dr. Alexis Kuerbis, a researcher who also works with older adults. “The first step is awareness on what might be

different for an older adult.” But because Baby Boomers use substances more than previous senior groups have, experts say treatment providers may have to find new ways to treat an old problem. “Everything we know about older adults and substance abuse probably doesn’t apply to Baby Boomers,” Dr. Kuerbis says. “All bets are off.”

“We’re grossly understaffed in being able to handle these problems.” - Dr. Dan Blazer, Duke University

HAS BEEN SHOWN TO PREVENT OVERDOSES AND STOP OPIOID “DESIGNER DRUGS” FROM AFFECTING THE BRAIN vaccine ? ARE A new

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Treating addiction with vaccines is a relatively new idea with many unanswered questions

that arise out of a lack of research. But a new study suggests vaccinating against illicit drugs is not only possible, it could be extremely effective. At the Scripps Research Institute in California, researchers were looking for a way to guard against the lethal and addictive effects of synthetic opioid “designer drugs.” A potentially deadly opioid, fentanyl, is often used as a heroin substitute or mix-in by drug dealers, so researchers developed a vaccine to try to mitigate its effects. Researchers injected mice with three rounds of the vaccine and then exposed them to doses of fentanyl. They found the vaccinated mice did not display any “high” behaviors even months after the last series of vaccine injections. Researchers say the immune systems of the mice developed antibodies that successfully blocked the drug from reaching the brain. “The results were the best we’ve ever seen for any drug vaccine,” says Paul Bremer, a graduate student at Scripps Research Institute who worked on the study.

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The results were the best we’ve ever seen for any drug vaccine. - Paul Bremer, Scripps Research Institute

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“ WE WERE ABLE TO BLOCK EXTREMELY LARGE - Paul Bremer DOSES OF FENTANYL TO PROTECT AGAINST OVERDOSES

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SAFE AND POWERFUL Not only was the vaccine able to stop intoxication (something researchers suggest could aid in opioid addiction treatment), the vaccine also proved extremely effective in blocking the potentially lethal effects of fentanyl as well. While the chemical is not necessarily toxic in itself, it does produce psychoactive effects that can shut down breathing and stop a person’s heart. Researchers say mice injected with the vaccine could withstand doses of fentanyl up to 30 times the normal rate. “It was just a rst generation vaccine, but it did prove to be very potent,” Bremer says. “We were able to block extremely large doses of fentanyl to protect against overdoses.” A SINGLE PURPOSE Researchers say the vaccine would not protect against heroin or oxycodone, and a mixture of vaccines would be needed to protect against all opioids. But that was somewhat by design. To make sure the vaccine would not interfere with any medications a person may take responsibly later in life, researchers targeted speci c molecules so the vaccine would only block fentanyl and its derivatives.

“For unrelated drugs that you would be taking, there would be no effect from the vaccine,” Bremer says. LOOKING TOWARD THE FUTURE Although still in the early stages of development, researchers say the vaccine represents an exciting step forward in drug vaccine research. The lab is beginning more advanced trials on a similar heroin vaccine which should give them a better idea of how successful the fentanyl vaccine could become. But until more testing can be completed, researchers say they were pleased with the progress and excited for the future of vaccines in the treatment of addiction. “This concept of using a vaccine for addiction isn’t just an academic pursuit, it could really be used in practice,” Bremer says. “I think it’s really promising.”

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