Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

奖赏环路与阿片成瘾:喙内侧被盖核的调节作用

喙内侧被盖核(RMTg)位于腹侧被盖区(VTA)的尾部, 富含抑制性的γ-氨基丁酸(GABA)能神经元.RMTg是中脑边缘多巴胺系统的一个综合调节器.它的GABA能神经元接受外侧缰核(LHb)的输入, 然后投射到VTA多巴胺能神经元, 进而抑制多巴胺的释放.这三个脑区是奖赏环路的重要组成部分, 其中RMTg在阿片类物质激活的奖赏环路中尤为重要.阿片类物质主要通过抑制RMTg GABA能神经元使VTA多巴胺能神经元去抑制, 进而激活奖赏系统.因此, RMTg有望成为治疗药物成瘾(尤其是阿片成瘾)的一个重要靶点.此外, 胆碱类物质作用于RMTg的毒蕈碱受体能够抑制阿片类物质诱导的奖赏效应.未来研究应深入探讨RMTg调控的负性奖赏环路, 这对弱化觅药动机,促进消退和戒断具有重要意义.     

The relations among cry characteristics, demographic variables, and developmental test scores in infants prenatally exposed to methadone

This study examined the relations among developmental test scores, infants' demographic characteristics, and cry features. Cry features were strongly related to developmental test scores at all ages, suggesting that use of the infants' cry characteristics can help to identify those infants at greatest risk for later developmental problems.     

Behavioral pharmacology of methocinnamox: A potential new treatment for opioid overdose and opioid use disorder

Opioid overdose and opioid use disorder continue to be significant public health challenges despite the availability of effective medications and significant efforts at all levels of society. The emergence of highly potent and efficacious opioids such as fentanyl and its derivatives over the last decade has only exacerbated what was already a substantial problem. Behavioral pharmacology research has proven invaluable for understanding the effects of drugs as well as developing and evaluating pharmacotherapies for disorders involving the central nervous system, including substance abuse disorders. This paper describes a program of research characterizing a potent, selective, and long-lasting mu opioid receptor antagonist, methocinnamox, and evaluating its potential for treating opioid overdose and opioid use disorder. Studies in rodents and nonhuman primates demonstrate that methocinnamox prevents and reverses opioid-induced ventilatory depression and selectively blocks opioid self-administration. This work, taken together with rigorous in vitro and ex vivo studies investigating methocinnamox neuropharmacology, lays a solid foundation for the therapeutic utility of this potentially life-saving medication. Moreover, these studies demonstrate how rigorous behavioral pharmacological studies can be integrated in a broader drug discovery and development research program.     

ICU成人患者镇痛药物的使用：阿片类及其他

ICU患者经历着各种各样的疼痛,镇痛治疗对于ICU患者至关重要.目前可用于ICU成年患者的镇痛药物很多,主要有阿片类镇痛药、解热镇痛抗炎药和对某些特殊疼痛状态有效的药物.阿片类药物仍是非神经性疼痛的一线用药,使用最多的是阿片受体激动药,包括吗啡、芬太尼、舒芬太尼、瑞芬太尼等,其中舒芬太尼、瑞芬太尼在国内ICU中使用经验不多;阿片受体部分激动药在国内ICU使用很少,包括喷他佐辛、地佐辛等;非甾体类镇痛药在国内ICU使用也很少,包括氟比洛芬酯、帕瑞昔布等.本文旨在简单介绍舒芬太尼、瑞芬太尼、部分阿片受体激动剂及非甾体类镇痛药在ICU的应用.     

Endogenous opioid peptides contribute to associative LTP in the hippocampal CA3 region

The medial and lateral perforant path projections to the hippocampal CA3 region display distinct mechanisms of long-term potentiation (LTP) induction, N-methyl-d-aspartate (NMDA) and opioid receptor dependent, respectively. However, medial and lateral perforant path projections to the CA3 region display associative LTP with coactivation, suggesting that while they differ in receptors involved in LTP induction they may share common downstream mechanisms of LTP induction. Here we address this interaction of LTP induction mechanisms by evaluating the contribution of opioid receptors to the induction of associative LTP among the medial and lateral perforant path projections to the CA3 region in vivo. Local application of the opioid receptor antagonists naloxone or Cys2-Tyr3-Orn5-Pen7-amide (CTOP) normally block induction of lateral perforant path-CA3 LTP. However, these opioid receptor antagonists failed to block associative LTP in lateral perforant path-CA3 synapses when it was induced by strong coactivation of the medial perforant pathway which displays NMDAR-dependent LTP. Thus strong activation of non-opioidergic afferents can substitute for the opioid receptor activation required for lateral perforant path LTP induction. Conversely, medial perforant path-CA3 associative LTP was blocked by opioid receptor antagonists when induced by strong coactivation of the opioidergic lateral perforant path. These data indicate endogenous opioid peptides contribute to associative LTP at coactive synapses when induced by strong coactivation of an opioidergic afferent system. These data further suggest that associative LTP induction is regulated by the receptor mechanisms of the strongly stimulated pathway. Thus, while medial and lateral perforant path synapses differ in their mechanisms of LTP induction, associative LTP at these synapses share common downstream mechanisms of induction.     

Look into my eyes: Gaze direction and person memory

The current research considered the effects of gaze direction on a fundamental aspect of social cogition: person memory. It was anticipated that a person's direction of gaze (i.e., direct or averted) would impact his or her subsequent memorability, such that recognition would be enhanced for targets previously displaying direct gaze. In Experiment 1, participants were presented with faces displaying either direct or averted gaze in a person‐classification (i.e., conceptual) task. Then, in a surprise memory test, they were required to report whether a presented face had been seen before. As expected, a recognition advantage was observed for targets displaying direct gaze during the initial classification task. This finding was replicated and extended in a second experiment in which participants initially reported the spatial location (i.e., perceptual task) of each face. We consider the implications of these findings for basic aspects of social‐cognitive functioning and person perception.     

药物成瘾机制与手术戒毒研究进展

本文从神经束路学、神经生理学、神经化学和分子神经生物学等方面分析了药物成瘾的病理生理学机制。探讨了立体定向手术戒毒的理论依据及发展方向：通过射频毁损或脑深部电刺激,部分破坏或抑制脑内异常兴奋点,阻断药物刺激引起的病理性信息传递,进而打破药物引起的病理性平衡,通过脑功能的代偿作用和手术后适当的心理行为康复治疗使成瘾相关环路在新水平上重建相对健康的平衡,进而达到减轻药物心理依赖、降低复吸率的目的。     

关于手术戒毒规范化开展的思考

吸毒成瘾是严重的医学和社会学问题。国内、外对吸毒成瘾采取的治疗方案由脱毒、防复吸和回归社会三个相互关联的方法构成。但收效甚微,复吸率居高不下。西安第四军医大学唐都医院神经外科在动物实验和借鉴以往经验的基础上,将立体定向技术用于毁损脑内与毒品心理依赖密切相关的关键位点的异常部分,对其异常功能进行调整,从而达到彻底戒毒的目的,取得了良好的疗效。本文介绍了手术戒毒在我国的发展历史,提出了规范化开展手术戒毒的建议。