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Objective: The current study examined the mediating role of distress tolerance on the association between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use among an ethno-racially diverse sample of young adults with current pain. Methods: Participants were 141 undergraduate college students (78.7% female, M age = 22.50, SD = 5.41) who reported experiencing current pain. Results: Results indicated that distress tolerance statistically significantly explained the relationship between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use after controlling for the variance accounted for by pain intensity, negative affectivity, gender, and other substance misuses. Conclusions: Clinical implications are discussed in terms of targeting distress tolerance in the context of pain-related disability among young adults with pain who are at risk for opioid misuse.

Objective: This study assessed undergraduate unhealthy substance use, levels of knowledge about opioid pharmacology, unhealthy use and safety, and students' perceptions about their level of knowledge. Participants: Participants were undergraduate students at a large, private university in the Northeast. Methods: This study employed a cross-sectional study design using an online survey. A convenience sample of undergraduate students (N = 317) described their actual and perceived levels of opioid knowledge and their self-reported substance use. Results: Objective answers to quiz-style questions about opioids showed knowledge deficits. Participants rated themselves as slightly less knowledgeable than the "average student." Ten percent of students surveyed had used opioids unhealthily at some point in their lifetime. Those reporting unhealthy opioid use had higher subjective and objective opioid knowledge scores. Conclusions: University students' subjective and objective knowledge of opioids warrants more effective and engaging substance use education on college campuses.

Introduction: Opioid use disorder (OUD) is a critical health issue in the USA. Pennsylvania has the third highest number of drug overdose deaths per year, with the COVID-19 pandemic worsening these trends. Stigmatising beliefs towards OUD are associated with negative health outcomes, and there is a need for a larger evidence base on OUD stigma reduction strategies. This study reports on the creation and implementation of "Life Unites Us," a digital media campaign which uses a collective impact framework to address OUD stigma reduction across Pennsylvania. Method: "Life Unites Us" consists of various components, including a general public media campaign which uses education and contact-based strategies; engagement with stakeholders and advocates in community-based organisations across the state; and a data sharing website to inform the public of previously unavailable OUD stigma statistics. Each campaign component contributes to the overall collective impact framework. Results: Digital metrics showed 755 followers across the "Life Unites Us" social media pages, and 2,826 total website users with an average of 565 users per month. The campaign has partnered with 60 community based organisations, 921 individuals receive the monthly email and 11 influencers have posted 23 times and achieved over 13,000 engagements and a reach of 661,000. The campaign hosted 5 webinars with 520 attendees and an overall 64.1% attendance rate. Conclusion: This study fills a gap in the need for evidence-based digital interventions to address OUD-related stigma. The positive process metrics from the first 6 months suggest that this model may be an important addition to research on approaches to reduce OUD stigma.

Concurrent use of cocaine and heroin (speedball) has been shown to exert synergistic effects on dopamine neurotransmission in the nucleus accumbens (NAc), as observed by significant increases in extracellular dopamine levels and compensatory elevations in the maximal reuptake rate of dopamine. The present studies were undertaken to determine whether chronic self-administration of cocaine, heroin or a combination of cocaine:heroin led to compensatory changes in the abundance and/or affinity of high- and low-affinity DAT binding sites. Saturation binding of the cocaine analog [(125) I] 3β-(4-iodophenyl)tropan-2β-carboxylic acid methyl ester ([(125) I]RTI-55) in rat NAc membranes resulted in binding curves that were best fit to two-site binding models, allowing calculation of dissociation constant (Kd ) and binding density (Bmax ) values corresponding to high- and low-affinity DAT binding sites. Scatchard analysis of the saturation binding curves clearly demonstrate the presence of high- and low- affinity binding sites in the NAc, with low-affinity sites comprising 85 to 94% of the binding sites. DAT binding analyses revealed that self-administration of cocaine and a cocaine:heroin combination increased the affinity of the low-affinity site for the cocaine congener RTI-55 compared to saline. These results indicate that the alterations observed following chronic speedball self-administration are likely due to the cocaine component alone; thus further studies are necessary to elaborate upon the synergistic effect of cocaine:heroin combinations on the dopamine system in the NAc., (© 2014 Wiley Periodicals, Inc.)

Background: Adolescent opioid abuse is on the rise, and current treatments are not effective in reducing rates of relapse. Our previous studies demonstrated that social housing conditions alter the acquisition rate of morphine conditioned place preference (CPP) in adolescent mice. Specifically, the acquisition rate of morphine CPP is slower in morphine-treated animals housed with drug-naïve animals. Thus, here we tested the effect of social housing conditions on the development of morphine dependence and the extinction rate of an acquired morphine CPP., Methods: Adolescent male mice were group-housed in one of two housing conditions. They were injected for 6 days (PND 28-33) with 20 mg/kg morphine. Morphine only mice are animals where all four mice in the cage received morphine. Morphine cage-mate mice are morphine-injected animals housed with drug-naïve animals. Mice were individually tested for spontaneous withdrawal signs by quantifying jumping behavior 4, 8, 24, and 48 h after the final morphine injection. Then, mice were conditioned to acquire morphine CPP and were tested for the rate of extinction., Results: Morphine cage-mates express less jumping behavior during morphine withdrawal as compared to morphine only mice. As expected, morphine cage-mate animals acquired morphine CPP more slowly than the morphine only animals. Additionally, morphine cage-mates extinguished morphine CPP more readily than morphine only mice., Conclusions: Social housing conditions modulate morphine dependence and the extinction rate of morphine CPP. Extinction testing is relevant to human addiction because rehabilitations like extinction therapy may be used to aid human addicts in maintaining abstinence from drug use., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The prohormone convertases, PC1/3 and PC2 are thought to be responsible for the activation of many prohormones through processing including the endogenous opioid peptides. We propose that maintenance of hormonal homeostasis can be achieved, in part, via alterations in levels of these enzymes that control the ratio of active hormone to prohormone. In order to test the hypothesis that exogenous opioids regulate the endogenous opioid system and the enzymes responsible for their biosynthesis, we studied the effect of short-term morphine or naltrexone treatment on pituitary PC1/3 and PC2 as well as on the level of pro-opiomelanocortin (POMC), the precursor gene for the biosynthesis of the endogenous opioid peptide, β-endorphin. Using ribonuclease protection assays, we observed that morphine down-regulated and naltrexone up-regulated rat pituitary PC1/3 and PC2 mRNA. Immunofluorescence and Western blot analysis confirmed that the protein levels changed in parallel with the changes in mRNA levels and were accompanied by changes in the levels of phosphorylated cyclic-AMP response element binding protein. We propose that the alterations of the prohormone processing system may be a compensatory mechanism in response to an exogenous opioid ligand whereby the organism tries to restore its homeostatic hormonal milieu following exposure to the opioid, possibly by regulating the levels of multiple endogenous opioid peptides and other neuropeptides in concert., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Teach-Ins have historically been used as a way for educators to raise knowledge and awareness around an urgent social problem. We report findings from an action evaluation of the Bowling Green State University (BGSU) Opioid Awareness Teach-In, which was designed to (a) make clear that the BGSU community believes we can work to change the story of the opioid epidemic in northwest Ohio and (b) raise awareness of resources available for those struggling with opioid dependence in our community. Campus wide, anonymous questionnaires administered to students, faculty, and staff before (n = 275) and after (n = 140) the Teach-In indicated positive, and statistically significant, changes in knowledge of resources available, treatment options, and the attitude that BGSU is a community that cares about those struggling with opioid addiction. Qualitative feedback suggests that the Teach-In was helpful as a step toward changing the story and inspiring hope. In particular, our work to facilitate communication and awareness around opioid addiction, and reduce the silence and stigma associated with addiction, appears to have resonated strongly with participants.

This article offers a longitudinal computational-rhetorical analysis of biomedical writing on opioids. Using a corpus of 1,467 articles and essays published in the "New England Journal of Medicine" and the "Journal of the American Medical Association" between 1959 and May 2019, this study evaluates diachronic shifts in (a) the framing of opioid pharmacology, (b) the relative attention paid to pain management versus opioid dependence risks, and (c) the distribution of statements related to physicians' primary ethical obligations. The results of these analyses largely disconfirm different current accounts of shifting physician rhetoric around opioids and pain management leading up to the recognition opioid epidemic. Most notably, the results also suggest that biomedical debates surrounding opioids are serving as proxy arguments for shifting primary bioethical obligations from individual patients to public health.

The urgency of this study has become vivid in the light of the growing problem of prevalence and use of new synthetic drug types. Lately there has been a tendency of expanding the range of psychologically active substances (PAS) used by addicts with the purpose of their illegal taking. The aim of this research is an attempt of systematizing and classifying "design" drugs according to their chemical structure, neurochemical mechanisms of action and clinical manifestations. As a result, we have found that they can be divided into ten big groups. This classification will allow to better arrange new clinical phenomenology in modern addictology. This paper would be useful for psychiatrists, experts in narcology, as well as for personnel of institutions and agencies engaged in anti-drug activity.

Approximately 70% of 67,367 drug overdose deaths involved opioids with rates 4 times higher than in 1999. The purpose of this systematic review is to assess the effectiveness of psychosocial interventions in opioid cessation. The search criteria for this review were: (a) published in English language between 2014 and 2019; (b) indexed in MEDLINE/PubMed, CINAHL, AltHealthWatch, and SCOPUS. Articles were selected based on predetermined criteria. 11 interventions with a combined total of 916 individual and 52 dyad participants met the eligibility criteria. The present evidence indicates that psychosocial interventions may lead to opioid cessation and improved quality of life. More large scale, rigorous randomized control trials using behavioral health theories are needed.

The number of deaths caused by the use of heroin or prescription pain killers nationwide has increased annually over the past decade with some of the most rapid growth occurring in the nation's most rural areas. This qualitative study examines the responses of districts and superintendents to this growing health crisis in twelve rural school districts in western Pennsylvania, an area heavily affected by the recent opioid epidemic. I analyze how superintendents in these districts worked with their local school boards and communities to develop district programming to address local opioid misuse and addiction. I find that the capacity of superintendents to respond to the opioid crisis in their districts was at times limited by local perspectives of place and drug addiction, which justified limited support for district efforts to target this crisis. This research, however, also finds that the capacity of educational leaders to respond to this crisis expanded when community perspectives changed, typically after a community incident that stirred public support for responses to this crisis. However, despite these constraints or supports for leadership action, district responses to this crisis largely predicated on the ability of superintendents to successfully act on and within their unique zone of tolerance.

New developments in the treatment of mothers and infants affected by opioid addiction point to the promising effects of interventions that adopt a developmental perspective, occur concurrently with addiction treatment, and target the parent-infant relationship as early as possible. In this article, the authors provide general guidelines for clinicians who wish to use attachment-informed, mentalization-based approaches to support mother-child relationships during a mother's recovery from addiction. They share an update on research from "Mothering From the Inside Out (MIO)," an evidence-based individual parenting therapy developed for mothers in addiction treatment.

We compared two strategies of prize-based contingency management (CM) in methadone-maintained outpatients. Urine was tested thrice weekly for 5 weeks pre-CM, 12 weeks CM, and 8 weeks post-CM. Participants were randomly assigned to a cocaine contingency (four prize draws for each cocaine-negative urine, N = 29) or an opiate-cocaine contingency (one draw for each urine negative for opiates or cocaine, four draws if negative for both, N = 38). There were no group differences in cocaine abstinence during CM or post-CM and no differences in opiate abstinence during CM. Opiate abstinence was greater in the opiate-cocaine group post-CM, and heroin craving was reduced in this group during and post-CM. Draws earned per cocaine-negative urine (four vs. one) did not affect cocaine use. (Contains 1 table and 3 figures.)

This paper critically examines methadone treatment from the perspective of adult and community education and questions the absence of rehabilitation. It identifies biomedicine and the methodology of evidence based medicine as the discourses that determine our understanding of addiction and treatment. It is especially critical of psychiatry for the over medicalisation of addiction treatment and the communities uncritical acceptance of the assumptions of medicine. The paper then looks at the Crinan project, as a model of good practice in drug treatment and asks what makes adult and community education an effective component of treatment that works uniquely in a way that medical model does not?