Opioid use disorder: current trends and potential treatments

Opioid use disorder (OUD) is a major public health threat, contributing to morbidity and mortality from addiction, overdose, and related medical conditions. Despite our increasing knowledge about the pathophysiology and existing medical treatments of OUD, it has remained a relapsing and remitting disorder for decades, with rising deaths from overdoses, rather than declining. The COVID-19 pandemic has accelerated the increase in overall substance use and interrupted access to treatment. If increased naloxone access, more buprenorphine prescribers, greater access to treatment, enhanced reimbursement, less stigma and various harm reduction strategies were effective for OUD, overdose deaths would not be at an all-time high. Different prevention and treatment approaches are needed to reverse the concerning trend in OUD. This article will review the recent trends and limitations on existing medications for OUD and briefly review novel approaches to treatment that have the potential to be more durable and effective than existing medications. The focus will be on promising interventional treatments, psychedelics, neuroimmune, neutraceutical, and electromagnetic therapies. At different phases of investigation and FDA approval, these novel approaches have the potential to not just reduce overdoses and deaths, but attenuate OUD, as well as address existing comorbid disorders

Insomnia severity as a mediator of the association between mental health symptoms and alcohol use in young adult veterans

PurposePrior research has documented associations between mental health and alcohol use, mental health and insomnia, and insomnia and alcohol use. This study examined insomnia severity as a mediator of the association between mental health and alcohol-related outcomes in young adult veterans.ProceduresVeterans aged 18-34 years (N=622, 83% male) who reported drinking in the past year completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants reported symptoms of depression and posttraumatic stress disorder (PTSD) at baseline, insomnia severity at one month, and alcohol use and related consequences at baseline and one month. Mediation analyses using bootstrapped confidence intervals were used to examine the indirect effects of baseline mental health symptoms on alcohol-related outcomes at one month via insomnia severity.Main findingsInsomnia severity was associated with both drinking quantity and alcohol-related consequences. Greater depressive (but not PTSD) symptoms were associated directly with more alcohol-related consequences. Neither depressive nor PTSD symptoms had direct effects on drinking quantity when controlling for the other mental health symptoms (e.g., depressive symptoms did not predict drinking quantity when controlling for symptoms of PTSD). However, symptoms of depression and PTSD predicted drinks per week and alcohol-related consequences indirectly through insomnia severity.ConclusionsSymptoms of depression and PTSD increase risk for alcohol use and related consequences in part by increasing symptoms of insomnia. Findings suggest that insomnia may be an appropriate target for prevention and intervention efforts among heavy-drinking Veterans reporting symptoms of depression or PTSD

Measured and predicted energy consumption in entry level homes

Energy efficiency of all forms is a major area of research; particularly in housing. Engineers, working along side of builders and architects, are designing homes to be more energy efficient than ever. Recent trends have shifted the energy savings focus to smaller, entry level housing. Recent advances in computers have enabled powerful simulations to be used to predict energy savings in homes. The Florida Solar Energy Center (FSEC) is developing software, Energy Gauge USA, that talces advantage of today\u27s powerful computer systems to run detailed hourly simulations. Measured hourly data from three entry level homes in Apopka, FL, was compared to the simulated hourly output data of Energy Gauge USA to assess the validity of the simulation. These three homes were built with different building techniques. The monitoring period took place under unoccupied conditions during a summer month with varying internal thermostat settings. Outside weather data was recorded and used in the simulation run. Overall, the simulation is very accurate in predicting energy consumption in entry level homes. Confidence intervals for the ratio of the variances and the difference of the means show very promising results. Additionally, the differences are centered around zero with no patterns or trends. These results will provide the developers of the software with a solid foundation of the accuracy of the software

A review of immunotherapeutic approaches for substance use disorders: current status and future prospects.

Substance use disorders (SUDs) have been a major public health challenge for decades and continue to cause significant morbidity and mortality worldwide. Due to limitations in pharmacologic treatment options, there remains a significant need for the development of novel immunotherapeutic approaches. In this review, we discuss the therapeutic potential of vaccines for SUDs. Although early preclinical animal studies were optimistic and successful, few vaccines have reached human clinical trials. Only nicotine and cocaine vaccines have successfully advanced to Phase 3 clinical trials and neither are currently available as a treatment option. Various innovative approaches in vaccine design have been made to overcome limitations and improve immunogenicity, including the use of nanoparticles, synthetic haptens, and more immunogenic adjuvants. While success has thus far been elusive, with substantial scientific advancements in vaccine technology, immunotherapy remains a promising and viable option for the treatment of SUDs

Evaluation Of EnergyGauge. Usa , A Residential Energy Design Software, Against Monitored Data

A new software, EnergyGauge USA®, is being developed for calculation of energy use in residential buildings. A simplified user interface allows buildings to be quickly defined and evaluated. Utilization of the DOE-2.1E energy simulation engine brings the computing power of hourly simulation to designers and raters. The software has enhancements to better simulate duct systems, air infiltration, attic and foundation thermal performance, heat pump part load characteristics and internal moisture capacitance. A recurring question with building energy software, regardless of the calculation rigor, is the relative accuracy of the estimates, particularly for cooling loads. To address this question, the software was used to estimate the hourly air conditioning electrical demand in three homes extensively monitored in Apopka, Florida. Each of the homes were unoccupied, and were identical in layout and orientation, yet contained different efficiency measures. A conventional concrete block home served as the project control house while a second had better insulated walls (autoclaved aerated concrete) and double-glazed windows. The third home, constructed with wood frame walls, had solar-control windows and an attic radiant barrier. Building geometry, construction and features were entered into the software with measured values being used for critical inputs. Monitored meteorological data was used to create weather files for the simulation and measured interior temperatures were input for each building. The resulting hourly simulation predictions for air conditioning power werethen compared to the monitored values for September 1998. Analysis showed excellent correspondence between the simulated and actual data. Average error was less than 4 percent for average hourly and less than 6 percent for peak hour air conditioning usage. Maximum errors were about 10 percent

Moral injury in the context of substance use disorders: a narrative review.

The rate of annual drug overdose deaths in the USA recently topped 100,000 (CDC/National Center for Health Statistics 2021), an illustration of the critical need to prevent and treat substance use disorders (SUDs). As a complex, chronic medical condition, substance use treatment requires psychological, emotional, and spiritual interventions along with medical care. The recently developed concept of moral injury has been increasingly studied and applied to military service members who experience conflict between the expectations or survival needs of combat and their moral values. This review explores whether moral injury, along with the related emotional, psychological, and spiritual symptoms, can also develop in the context of SUDs. This review identified 5 manuscripts related to moral injury arising in a substance use context. These studies were small in sample size and qualitative in nature but did indicate the presence of moral injury within the context of substance use. Further studies are needed to better understand and treat moral injury related to SUDs. A conceptualization of how moral injury may arise in the context of substance use is presented here. It is suggested that the activation of the primitive dopaminergic reward system causes a potential conflict between the experienced need for the addictive substance and a person's moral code or values. The moral injury resulting from this collision may impact treatment and recovery

Caffeine content of decaffeinated coffee

Abstract Caffeine is the most widely consumed drug in the world with coffee representing a major source of intake. Despite widespread availability, various medical conditions necessitate caffeinerestricted diets. Patients on certain prescription medications are advised to discontinue caffeine intake. Such admonition has implications for certain psychiatric patients because of pharmacokinetic interactions between caffeine and certain antianxiety drugs. In an effort to abstain from caffeine, patients may substitute decaffeinated for caffeinated coffee. However, decaffeinated beverages are known to contain caffeine in varying amounts. The present study determined the caffeine content in a variety of decaffeinated coffee drinks. In phase I of the study, 10 decaffeinated samples were collected from different coffee establishments. In phase 2 of the study, Starbucks | espresso decaffeinated (N --6) and Starbucks brewed decaffeinated coffee (N = 6) samples were collected from the same outlet to evaluate variability of caffeine content of the same drink. The 10 decaffeinated coffee samples from different outlets contained caffeine in the range of 0-13.9 mg/16-oz serving. The caffeine content for the Starbucks espresso and the Starbucks brewed samples collected from the same outlet were 3.0-15.8 mg/shot and 12.0-13.4 mg/16-oz serving, respectively. Patients vulnerable to caffeine effects should be advised that caffeine may be present in coffees purported to be decaffeinated. Further research is warranted on the potential deleterious effects of consumption of "decaffeinated" coffee that contains caffeine on caffeine-restricted patients. Additionally, further exploration is merited for the possible physical dependence potential of low doses of caffeine such as those concentrations found in decaffeinated coffee