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U NDERSERVED AND U NDETERRED PROLONGING THE PAIN Study suggests painkill- ers may be having the opposite effect in the long run

Coping With Discrimination Discriminatio in relation to substance abuse

Numbers Don’t Lie

No Woman no cry Congenital Insensi- tivity to pain

Are Vaccines The Answer?

STUDY METHODOLOGY Studying mice genetically modified to be without the Nav1.7 channel, Wood found that such mice had bodies that dis- played a large increase in certain genes responsible for creating opioid peptides. Opioid peptides occur naturally in the body as the body’s painkiller and have a similar effect as opioids. In making more of the opioid pep- tides, the mice were blocking any feelings of pain, which might be the reason people suffering from CIP also don't feel pain. Wood thought that if he gave mice a medicine that reversed the effect of the opioid peptides, it may reverse the disorder. He gave the mice naloxone—a medication used to reverse opioid overdoses—and it worked. Wood figured the same could be done for humans. “After a decade of rather disap- pointing drug trials, we now have confirmation that Nav1.7 is a key element in human pain,” Woods says. “The secret ingredient turned out to be good old-fashioned opioid peptides, and we have now filed a patent for combining low dose opioids with Nav1.7 blockers. This should replicate the pain- lessness experienced by people with rare mutations, and we have already successfully tested this approach in unmodified mice.” CONGENITAL INSEN- SITIVITY TO PAIN (CIP) is a very rare genetic mu- tation that prevents mes- sages of physical pain from reaching the brain.

Research researcher and his team of researchers studied a 39-year-old woman with CIP. Using a laser beam and a dose of naloxone, Wood helped the woman, who elected to partici- pate anonymously, feel pain for the first time in her life. “Used in combination with Nav1.7 blockers, the dose of opioid needed to prevent pain is very low,” says Wood in an UCL release. “People

Using a test subject with a ge- netic mutation that prevents her from feeling pain, scientists have conducted research that shows promise in creating more effec- tive painkillers—and potentially decreasing the need for addictive opioids. Congenital insensitivity to pain (CIP) is a very rare genetic muta- tion that prevents messages of physical pain from reaching the brain. Sufferers of the disorder, as babies, will chew their lips until they bleed. Toddlers have to deal with more potential for falls, bumps and being hurt by hot or sharp things. Adults are at a high- er risk of dying prematurely. The disorder leaves those afflict- ed without channels known as Nav1.7, which carry sodium to sensory nerves. Understanding this disorder and channels of pain reception and delivery has led re- searchers to study the disorder for ways to block pain in those who don't have the disorder. Research- ers thought they could block pain transporting channels in people without CIP so they can help those with chronic and painful ailments like arthritis. HELPING A WOMAN CRY In a study published by the journal Nature, John Wood, a University College London (UCL) Wolfson Institute for Biomedical

with nonfunctioning Nav1.7 produce low levels of opioids throughout their lives without de- veloping tolerance or experiencing unpleasant side effects.”

As for this work leading to com- plete cessation of pain, Wood tells the New Scientist that some research has found success, but nothing has led to the complete pain loss found in those that are naturally without Nav1.7 channels.

who doesn’t feel the Woman WHAT THE FUTURE HOLDS.... As for people with CIP, Woods says he doesn't know if treatment using nalox- one is an option. Long-term use of naloxone could have side effects. What Woods can say, definitively, is that the mice in the experiment felt as little pain as mice who did not have the Nav1.7 channel naturally. Woods, his team, and the rest of the field are working to fill in the re- search gaps to start answering these questions for humans. “We hope to see our approach tested in human trials by 2017 and we can then start looking into drug combinations to help the millions of chronic pain patients around the world,” Woods says. Imperial College London professor Kenji Okuse reacted to Wood’s findings to the New Scientist, saying that the research will provide more information to doc- tors about pain.

Could help in making better painkillers.

We hope to see our

“Opioids and Nav1.7 blockers could provide much stronger analgesics, but they will not necessarily be better for patients,” Okuse says. “If we take the combination therapy route, people would have to take opioids throughout the lifetime, which is not a welcome thing.”

approach tested in human trials by 2017 and we can then start looking

into drug combinations to help the millions of chronic pain patients around the world. — John Wood, University College London Wolfson Institute for Biomedical Research researcher

313.624.5897

Underserved And Undeterred Overcoming the unique challenges LGBTQ individuals face with addiction A s more and more addiction treatment centers are looking for ways to tailor programs to address the individual needs of clients, one section of the population is being largely overlooked. Advocates say treatment providers need to be more aware of the unique issues and barriers facing the LGBTQ community. Numbers don’t lie

For starters, statistics show substance abuse issues affect LGBTQ individuals at much higher rates than they do the heterosexual population. Some estimates show an addiction rate between 30 and 40 percent, compared to around 10 percent of the population in general. While statistics also show that LGBTQ individuals enter into treatment more readily than the rest of the country, they also face significantly higher animosity once in a program. Advocates say 46 percent of homosexual men and women have had a homophobic therapist, and 34 percent felt their sexuality was seen as irrelevant. While putting sexuality aside to address addiction directly may seem like a good thing at first glance, advocates say recognizing those differences is key to creating a lasting recovery. Need for understanding Understanding a person’s sexuality and gender identity can be as important as understanding their race or ethnic background in that it can uncover potentially hidden sources of stress or

trauma that may contribute to substance use. Just as counselors should consider the social experiences of African-Americans, so too should they consider the unique circumstances faced by members of the LGBTQ community. “In order to not continue to create trauma towards the LGBTQ community, the more culturally competent a person or work/recov- ery environment is, the better,” says Molly Gilbert, director of business development for the PRIDE Institute in Minnesota.

The PRIDE Institute specializes in addiction treatment for the LGBTQ community, and Gilbert says a lack of understanding or awareness by treatment providers can create barriers for people seeking treatment. Even for organizations that seek to become “inclusive” communities, they may not set up a program that accurately addresses LGBTQ concerns, or providers may not realize how they are doing harm to LGBTQ individuals, transgressions known as micro-aggressions. “Micro-aggressions occur daily towards the community and educating heterosexual colleagues, supporters and the rest of society is key in helping to diminish these daily slights and harm,” Gilbert says. Education first To improve treatment outcomes and the experi- ences of LGBTQ people in general, advocates say it’s vital that treatment pro-

viders, physicians, and social service employees educate themselves on

some of these unique challenges and barriers. But they also say LGBTQ people need to educate themselves as well. “Educating the LGBTQ community on the dangers of abuse of alcohol and drugs, and the fact that the community is actually being tar-

geted by institutions such as big tobacco, alcohol companies and drug manufacturers is key,” Gilbert says. With very few

LGBTQ-specific treatment centers across the country, advocates know many

LGBTQ individuals will end up in heteronormative treatment facilities. And while that can present prob-

lems, Gilbert says with the right education and the right system in place, recovery is attainable. “With the right therapy coexisting with a mainstream treatment center, we believe it is doable.”

ain relievers are supposed to relieve pain. It sounds simple enough, but new research suggests a common pain medication may actually be prolonging chronic pain. P Prolonging the Study suggests painkillers may be having the opposite effect in the long run Pain

“We were surprised that morphine was able to induce these really long-lasting changes,” says Dr. Peter Grace, the study’s lead author. Dr. Grace says the cause of the chronic pain in- crease has to do with cells that form part of the immune system. He says if those areas could be isolated or their effects reduced, the resulting pain may not be as great. “If it does turn out to be a relevant issue to patients, then what our study suggests is that targeting the immune system may be the key to avoiding these kinds of effects,” Dr. Grace says. “Opioids could essentially work better if we could shut down the immune system in the spinal cord.” The team’s research only looked at spinal cord injuries and morphine, and did not study other opioids that are commonly prescribed to pa- tients experiencing pain. But he said it’s likely drugs like Vicodin or OxyContin could affect other parts of the body in a similar way. “While we haven't actually tested other opioids in this particular paradigm, we predict that we would see similar effects,” Dr. Grace says.

Morphine is an opioid painkiller commonly prescribed in hospitals and clinics, and while it is effective in the short term, doctors don’t always consider the potential consequences for pain down the road. That’s why a team of researchers based out of the University of Col- orado - Boulder set out to study how morphine treatment affects chronic pain, and found some troubling results. The team, which used mice with spinal cord injuries, found that in mice not given morphine, their pain thresholds went back to normal about four to five weeks after the injury. But mice who were given morphine didn’t see their pain levels return to normal until around 10 to 11 weeks, meaning the use of morphine effectively dou- bled the length of their chronic pain.

Chronic problem Chronic pain can be debilitating for many people facing serious health problems, and it can also be a key factor in substance abuse. Many people report developing a dependence on opioids after having them prescribed for an injury. But new research suggests the number of people who develop dependency issues because of chronic pain may be far higher than people realize. A study from researchers at Boston Univer- sity looked at a group of nearly 600 people who had either used illicit substances or misused prescription drugs.

They found that 87 percent reported suffering from chronic pain, with 50 percent of those people rating their pain as severe. They also found that 51 percent of people who had used illicit drugs like marijuana, cocaine and heroin had done so to treat their pain. While many prevention ef- forts focus on recreational users, the numbers suggest that chronic pain plays just as prominent a role in substance abuse. “Many patients using illicit drugs, misusing prescription drugs and using alcohol reported doing so in order to self-medicate their pain,” the authors of the study wrote. “Pain needs to be addressed when patients are counseled about their substance use.”

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

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.

INSERT 7

VACCINES THE ANSWER

“

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

INSERT 7 “ WE WERE ABLE TO BLOCK EXTREMELY LARGE

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.

- Paul Bremer DOSES OF FENTANYL TO PROTECT AGAINST OVERDOSES

“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.”

safe and powerful

Discrimination, whether based on race, gender, or sexual orientation, has long been thought to be a contributor to substance abuse. Now a new study has confirmed the relationship between discrimination and addiction, but it’s also brought up many more questions that still need to be answered in order to improve treatment outcomes. Researchers at the University of Iowa recently com- pleted a peer review study in which they looked at 97 previous studies on discrimination and alcohol use. Their goal was to summarize the collective knowl- edge researchers have uncovered throughout the years, and what they found confirmed in more detail what many had previously suspected.

“Generally there is good scientific support, but the evidence is mixed for different groups and for types of discrimination.” - Dr.Paul Gilbert, University of Iowa

overtly racist or sexist to another person. But less research has been done on what are known as mi- cro-aggressions, small everyday occurrences that can rub a person the wrong way. That research is improving, but there are other factors that need to be more fully explored. While studies have looked at historical trauma in the African-American popula- tion, the concept has not been fully investigated with regards to Hispanic and Asian populations. “This notion of historic trauma could be really rel- evant to other groups, but it hasn't received much attention at all,” Dr. Gilbert says. “This is something we should pay attention to.” All of this adds up to the fact that treatment provid- ers may be missing a key piece of the substance abuse puzzle.

The team found that discrimination did indeed lead to an increase in drinking frequency, quantity of alcohol consumed, and in the risk for alcohol use disorders. Researchers say drinking can represent a coping mechanism in response to the stress caused by discrimination, and several studies showed clients acknowledging this direct link themselves. But when looking at specific populations and types of discrimi- nation, the picture becomes less clear. “The story is that generally there is good scientif- ic support, but the evidence is mixed for different groups and for types of discrimination,” says Dr. Paul Gilbert, the study’s lead author. “We don’t real- ly know comparing one type or one level to another.” For example, much research has been done on inter- personal discrimination where someone is

But just because the intricacies of how discrimination affects drink- ing aren’t yet fully understood, that doesn’t mean our current knowledge base can’t be helpful. Dr. Gilbert says simply knowing that experiences with discrimination can drive drinking could in- form the way treatment providers interact with clients, opening new areas of their lives to explore during treatment. “It can serve as sort of an early warning or indicator,” Dr. Gilbert says. “For treatment providers, it’s worth looking at: is there some- thing that may be keeping folks from accessing services or affecting outcomes?”

Dr. Gilbert says treatment providers should continue to address discrimination as part of a holistic approach to recovery. He says it will be up to researchers to fill

in the gaps to find the precise ways that discrimination affects drinking behavior. “We’ve got good evidence on this level of interpersonal discrimination,” Dr. Gilbert says. “We’ve gotten the low-hanging fruit, now it’s time to start working on the stuff that’s a little further up the tree.”

“It can serve as sort of an early warning or indicator.” - Dr. Paul Gilbert, University of Iowa

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