A monthly shot for opioid addiction: An option for some

Wynne Armand, MD
Wynne Armand, MD, Contributing Editor

Several long-term treatments can help people overcome opioid addiction. One of them, naltrexone, may help people who have trouble sticking with taking a pill every day. Naltrexone can be offered as a monthly injection called Vivitrol, which has been shown to help more people stay on treatment as compared to the pill form. However, it’s not for everyone, and like all treatments for opioid addiction, it must be used very carefully.

We should be ashamed if we don’t pass Tobacco 21 laws

Claire McCarthy, MD
Claire McCarthy, MD, Faculty Editor, Harvard Health Publications

Ninety percent of smokers had their first cigarette before turning 18. A movement to raise the legal age to buy tobacco in the United States to 21 hopes that making it more difficult for young people to start smoking may lead to a healthier population overall.

Is addiction a “brain disease”?

Michael Bierer, MD
Michael Bierer, MD, Contributor

A look into the “brain science” behind substance use disorders highlights the fact that for many people with addictions, “just say no” just doesn’t work. The biological underpinnings of addiction teach the brain to react unusually strongly if deprived of drugs, which can make recovering from an addiction incredibly difficult. Fortunately, it’s possible to teach the brain to rediscover healthier sources of joy and reward.

Why are doctors writing opioid prescriptions — even after an overdose?

Joji Suzuki, MD

A recent study of nearly 3,000 patients who had an overdose during long-term opioid treatment found that more than 90% of these patients continued to receive opioids — even after their overdose. Poor communication between emergency rooms and prescribing doctors is likely the culprit. What’s more, doctors receive little training in recognizing patients at high risk for overdose, or in treating addiction when they do spot it. An important strategy to address the current opioid crisis is to improve how doctors are educated about opioids.

The “right” goal when managing pain

Robert R. Edwards, Ph.D.
Robert R. Edwards, Ph.D., Contributing Editor

When it comes to pain management, focusing only on reducing the intensity of pain may lead to treatments that do as much harm as good. Ideally, pain-management plans should be tailored to each patient and include a range of therapies that not only reduce pain but also help improve pain-related quality-of-life problems.

The problem with prescription painkillers

Wynne Armand, MD
Wynne Armand, MD, Contributing Editor

Opioids are effective pain relievers. But sometimes people can develop a tolerance to these drugs, requiring increasingly higher doses of medication to achieve the same pain relief. And physical dependence — withdrawal symptoms when the drug is stopped — is also common. The increased availability of these drugs has put many people at risk for addiction, overdose, and even death.

Low-nicotine cigarettes may help determined smokers cut back

Mallika Marshall, MD
Mallika Marshall, MD, Contributing Editor

A study examining the effects of low-nicotine cigarettes on smoking behavior yielded surprising results. The study volunteers who smoked the low-nicotine cigarettes actually smoked less and had fewer cigarette cravings than those who smoked cigarettes with a higher level of nicotine. Although more research is needed before we can draw any conclusions, it’s possible that very-low-nicotine cigarettes might be a way to mitigate the health dangers of smoking for people determined not to quit.

Edible marijuana — a half-baked idea?

Patrick J. Skerrett, Former Executive Editor, Harvard Health

Marijuana-laced brownies have long been a way to get high. Now a new generation of “food companies” is taking the concept of edible marijuana in a somewhat scary new direction: marijuana-laced foods that mimic popular candies. These sweets could pose a danger to children, warns a Perspective article in today’s New England Journal of Medicine. From a marketing perspective, it’s a cute concept to sell Buddahfingers that look like Butterfingers, Rasta Reese’s that mimic Reese’s Peanut Butter Cups, or Pot Tarts that resemble Pop-Tarts. But the availability of edible marijuana products has led to an increase in emergency visits to hospitals because of kids accidentally eating edible marijuana products and in marijuana-related calls to poison and drug hotlines.

Report highlights the dangers of opioid painkillers

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

Opioid painkillers like hydrocodone and oxycodone offer blessed relief from pain. But the body gets used to them, requiring ever-higher doses. They are also addictive, cause side effects, and can kill. A report in the New England Journal of Medicine says prescription painkiller abuse accounts for about 17,000 deaths a year. Doctors are learning to say no to opioids, but have limited scientific guidance on when and how to best use them for chronic pain. Ideally, these drugs should prescribed for the shortest time possible and, if pain persists, a transition made to a non-addictive form of pain control. This may be other medications or specialized counseling from a pain specialist that might include complementary and alternative treatments, like acupuncture and meditation.

Heavy drinkers aren’t necessarily alcoholics, but may be “almost alcoholics”

Patrick J. Skerrett, Former Executive Editor, Harvard Health

Nearly one-third of American adults are “excessive” drinkers, but only 10% of them have alcohol use disorder (alcoholism). Those numbers, published yesterday in a national survey, challenge the popular idea that most people who drink too much are alcoholics. The new study, done by researchers with the CDC and the Substance Abuse and Mental Health Service Administration, found that about 70% of all American adults drink alcohol at least now and then, about 30% report excessive drinking, and 3.5% have alcohol use disorder. It is higher among heavy drinkers (10%) and binge drinkers, ranging from 4% among those who report binge drinking once or twice a month to 30% among those who binge drink 10 times or more in a month. The knowledge that only 10% of heavy drinkers are alcoholic may be reassuring, but that doesn’t mean the other 90% aren’t have problems with drinking. Some are what Drs. Robert Doyle and Joseph Nowinski call “almost alcoholics.”