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COCAINE | "The public needs to know that today's cocaine contains fentanyl"

mr peabody

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“A vast, uncontrolled experiment” — Ibogaine, 10 years on

by Loren DeVito, PhD | February 19, 2019

Nearly 10 years ago, I stepped out on a Saturday night to meet a friend for a movie in Davis Square. The movie, I’m Dangerous with Love, was playing as part of a special event. As I settled into the Somerville theater, I wasn’t quite sure what I was in for, or how this documentary would end up informing me of a revolution in medicine to come nearly a decade later.

Living dangerously: clandestine healing

The film followed Dimitri Mugianis, a former musician and recovering addict, as he bounced back and forth between his NYC base to treat people across the nation and in Canada. While the opioid epidemic is all around us in 2019, back then, the vernacular of addiction was still relegated to those taking illicit drugs like heroin. With no medical training, Dimitri set out to heal those addicted to drugs with an alkaloid from a traditional plant native to West Africa: ibogaine.

His clandestine healing sessions intrigued me immediately. This former rocker who treated his addiction using this very method was traveling to people’s homes to administer a plant that, in the majority of cases, almost immediately “cured” people. As a neuroscientist-in-training, every cell in my brain lit up.

How could this plant be so effective? How could no one in the West have heard of this “miracle”?

I watched captivated as Dimitri administered the plant, cared for people as they went through agonizing, albeit, brief detox. Then, as they awoke, he talked them through their new life. Of course, not everyone was able to maintain their abstinence long-term, but most people in the film did get a chance to live without drug dependency for a significant amount of time.

Nevertheless, this treatment was not without harm. In fact, ibogaine can cause severe cardiac side effects, which is extremely dangerous when treating people without a medical license at their homes with a drug that is not exactly mentioned in medical textbooks. After one such case, Dimitri realized he was treating patients without proper knowledge of the plant in its entirety. Therefore, he set out to Gabon to learn more about how the plant is traditionally used to better inform his practice.

After a brief discussion following the movie, I left the theater buzzed. As a good little scientist, I immediately pulled up PubMed (the science version of Google) when I got home to search for studies on ibogaine. While there were many studies using preclinical models, I could find very little information for its use in humans.

I filed ibogaine away as one of the cool things I would study when I had my own lab and could start pursuing (funding permitting) my own research passions, and that’s where ibogaine sat for many years—a paper in the accordion file of my brain—that is, until a few years ago.

Pharmacology of an ancient root

One night, I happened upon a study while numbly scrolling through social media. Researchers found that ibogaine enhances neuroplasticity in the brain. “I knew it!” I exclaimed to no one.

My heart started to race, and images appeared of the movie I had seen years before. Could this be how ibogaine helps people rapidly recover from addiction?

The part of the film that really struck a chord involved a scene with a woman who had taken ibogaine. The day after her treatment, she reported feeling as though her senses were “renewed”: Food tasted different, colors were brighter, and everything had changed overnight.

Neurogenesis occurs in the hippocampus, a part of the brain essential to memory and the region I happened to be studying in graduate school, as well as the olfactory regions in adults. The woman’s report following ibogaine made me think of neurogenesis and neuroplasticity immediately because a supply of new neurons and connections flooding the brain would likely cause these perceptions. Of course, I still didn’t know the first thing about the chemical properties of ibogaine, so I got to work.

Getting to know ibogaine

Ibogaine comes from the roots of Tabernanthe Iboga, a shrub native to West Africa. Lower doses are used to help alleviate fatigue, while higher doses are used in religious ceremonies. Noribogaine is the drug's active metabolite.

Ibogaine works by inhibiting the reuptake of neurotransmitters (brain chemicals), including serotonin, which may induce hallucinogenic experiences similar to other psychedelic substances. As I accidentally discovered one night, ibogaine also contributes to neuroplasticity, which is the brain’s ability to reorganize itself when presented with new information.

A preclinical study showed that ibogaine increases glial cell line-derived neurotrophic factor, a substance that promotes the survival and differentiation of cells in the brain. Additionally, noribogaine changes the structure of brain cells, affecting how they interact with other cells.

Clinical studies have found that a single oral dose of ibogaine can significantly reduce cravings for cocaine and heroin, as well as symptoms of depression, for up to 30 days following treatment. While long-term effectiveness of the treatment varies, a survey of patients who received ibogaine treatment in Mexico showed that 30 percent abstained from opioid use for up to two years, with 41 percent reporting abstinence for more than six months, across a three-year follow-up period. There is also some evidence that ibogaine may help those with alcohol addiction.

A blocked path to progress

While the Food and Drug Administration (FDA) entertained the idea of approving a clinical trial for ibogaine in 1993, they decided against it due to safety concerns, despite the fact that people were getting treated in droves at clinics outside the U.S.

In 2005, a few years before the movie came out, the director of anti-addiction drug development at the National Institute on Drug Abuse (NIDA) referred to ibogaine as a "vast, uncontrolled experiment"—a pretty accurate description then—but times have changed.

Traditional medicines like cannabis and psilocybin finally started to hit the mainstream (i.e., in the West) a few years ago and are making significant strides toward legalization through rigorous clinical trial studies. Essentially, we are finally realizing their potential after thousands of years of anecdotally documented benefits.

Flash-forward to today, and we now have quite a surplus of data on ibogaine. In fact, a current search on ibogaine produces more than 450 hits, a far higher number than when I originally started on my expedition. Yet, it still begs the question of the true effectiveness of ibogaine and, most importantly, its safety.

Unsafe unknowns

While ibogaine remains illegal in the U.S., people continue to travel to clinics throughout the world in an attempt to break the cycle of addiction. Despite a decade of additional research, safety concerns remain significant.

Ibogaine treatment can be deadly. Administration of the drug can cause serious cardiac effects since ibogaine decreases the heart rate. Unfortunately, these effects can come on quite quickly. While a small clinical trial identified the time it takes to clear a small dose of ibogaine from the body, additional study is needed to better understand how to safely dose ibogaine.

While there is evidence that low-dose administration of ibogaine can effectively reduce withdrawal symptoms and cravings, it’s not possible to guarantee the safety of ibogaine treatment. People who take ibogaine do so at their own risk. Ibogaine remains an illegal substance in the U.S., so, is there any hope for ibogaine? Yes, with more research, of course.

A Phase 2 clinical trial is currently underway evaluating ibogaine for alcohol addiction. The Multidisciplinary Association for Psychedelic Studies (MAPS) has conducted two observational studies in Mexico and New Zealand. U.S. state legislators are also proposing new bills to fund research for ibogaine, and one Republican lawmaker in Iowa just filed a state bill to legalize its medical use.

Ten years later and there is still a lot of work to be done, but I’m Dangerous with Love opened my eyes to the immense potential of using an ancient plant to solve a modern health crisis, and for that, I thank you, Dimitri.

https://prohbtd.com/a-vast-uncontrol...10-years-later
 
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mr peabody

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Not yesterday's cocaine: Death toll rising from tainted drug

by Laura Ungar | Kaiser Health News | Dec 2 2019

A pain pill prescription for nerve damage revived Gwendolyn Barton's long-dormant addiction last year, awakening fears she would slip back into smoking crack cocaine.

She'd done that drug and others for about 20 years before getting sober in 2008. But things were different back then. This time, the 62-year-old knew she needed to seek treatment before it was too late.

"If I used today," she said, "I'd be dead."

The powerful opioid fentanyl is often mixed into cocaine, turning the stimulant into a much bigger killer than the drug of the past. Cocaine-related overdoses took the lives of nearly 14,000 Americans in 2017, up 34% in just a year, the latest federal figures show. And they're expected to soar even higher as cocaine's popularity resurges.

Barton, who is African American, is wise to be wary. Deaths are rising most precipitously among African Americans, who are more likely to use cocaine than whites and fatally overdosed at an 80% higher rate.

But the scourge is festering quietly, overshadowed by the larger opioid epidemic that kills tens of thousands each year, the vast majority of them white.

More than 30 states have seen cocaine death rates rise since 2010, with Ohio leading the way. Overdoses from crack and powder cocaine killed 14 of every 100,000 Ohioans of all races in 2017—seven times more than in 2010, according to the University of Minnesota's State Health Access Data Assistance Center.

Colin Planalp, senior research fellow with the center, said deaths have risen steeply in rural and urban areas across America since 2000, and the increase is directly related to the national opioid crisis.

Most of the time, fentanyl is the stealth culprit, posing a particular danger to longtime cocaine users who may be older, sicker and unaccustomed to the effects of opioids.

"Your whole system is kind of thrown a curveball," said Katherine Engel, director of nursing at the Center for Addiction Treatment in Cincinnati. "You're an opiate virgin, so to speak."

Tom Synan, police chief in Newtown, just outside Cincinnati, said the risk extends to cocaine users who also have used older opioids such as heroin because fentanyl is 50 times more potent.

"In the '70s, a 'speedball' was a mix of cocaine and heroin. I call this 'speedball 2.0." Fentanyl has made it much worse," he said. "It's made every drug people are addicted to into a crisis."

In May, in Cincinnati's county of Hamilton, cocaine overdoses killed six people over 10 days.

The crisis is growing as more people use cocaine.

A federal survey showed about 2 million Americans used the stimulant regularly in 2018, up from 1.4 million in 2011. One in 100 African Americans used the drug regularly last year, a rate 40% higher than among whites.

Supply helps drive use. A 2018 report by the U.S. Drug Enforcement Administration says record cocaine production in Colombia, the primary source for cocaine seized in the United States, has widened the cocaine market and pushed down prices. The agency expects the trend to continue.

Synan said the supply has ebbed and flowed over the years and cocaine never went away. What's different now, he said, is the intentional and unintentional addition of fentanyl.

Sometimes, law enforcement experts said, dealers spike cocaine with the inexpensive synthetic opioid to hook people. Other times, it gets mixed in through sloppy handling or packaging somewhere along the way.

"The reason they're putting it in is it's cheap," said Thomas Fallon, commander of the Hamilton County Heroin Coalition Task Force. "Also, they're not chemists. They don't always know what they're doing."

Still, longtime cocaine users often trust their dealers. "They're less likely than heroin or pill users to carry the opioid overdose reversal drug naloxone," treatment professionals and police say, "because they don't think of themselves as opioid users and don't believe they'll need it."


"A new life awaits you in the Off-world Colonies..."

While some users overdose and die from cocaine mixed with fentanyl, others come to crave the potent combination for its high.

"Instead of being a deterrent, it's an incentive for some," said Evonne Stephenson, a nurse practitioner at the Urban Minority Alcoholism and Drug Abuse Outreach Program of Cincinnati. "Everyone thinks they're invincible."

Actually, drug use makes them more vulnerable to serious health problems or death, especially as they age. Indeed, the steepest rise in cocaine-related overdose deaths nationwide was among people 45 to 54 years old.

William Stoops, a University of Kentucky professor who studies drug and alcohol addiction, said longtime cocaine use causes cardiovascular problems, which raises the risk of dying from an overdose even before fentanyl is added to the mix.

Barton likens doing cocaine these days to a game of Russian roulette.

"One person might get super high," she said. "The next one may take it and die."

Efforts to reduce these deaths face several obstacles.

Long-simmering resentment among African Americans around the criminalization of cocaine addiction in the 1980s and '90s fuels an ongoing mistrust of law enforcement and public health efforts.

Back then, possessing 5 grams of crack, which many associated with low-income African Americans, brought the same prison sentence as possessing 500 grams of powder cocaine, which many associated with middle-class or affluent whites.

"The way people think about and tackle drug use has been influenced by who we think uses them," said Jeffrey Coots, who directs John Jay College of Criminal Justice's "From Punishment to Public Health" initiative in New York.

And though African Americans use opioids, too, today the drugs are typically associated with white users.

"There's a thought that no one cared until a bunch of white people started dying," said Stephenson, the Cincinnati nurse practitioner. "That's so tragic."

Synan said he's heard this sentiment. People ask: "'Why do you care now if you didn't care back then?'" he said. "So you have to overcome that. Whether it's real or perceived, it doesn't matter, because it's still an issue."

Synan said he understands the concerns and acknowledged that society sees opioids more through a medical lens. But he said "that's partly because of an evolving understanding of addiction and the sheer numbers of overdose deaths in recent years, which require urgent action."

To be sure, overdoses involving opioids kill more Americans: 47,600 in 2017, including 5,513 African Americans. Overdoses involving cocaine killed 3,554 African Americans—although categories overlap because deaths may involve more than one drug.

Another challenge: There's less in the treatment arsenal for cocaine addiction. While medications such as Suboxone and methadone treat people hooked on opioids, there are no federally approved medications to treat cocaine problems, even though researchers were testing promising medications nearly 15 years ago.



Public health officials say they're focusing more on cocaine addiction in light of today's deadly overdose threat, and trying to address the larger issue of addiction in general.

"What we'd certainly like to see more of is community-level interventions that go at the drivers of drug use in the first place—seeing it as the symptom of a problem," Coots said.

In Ohio, the Hamilton County Heroin Coalition—which plans to change its name to reflect a focus on all addictions—has reached out to African Americans through black churches, public forums and community leaders. It tries to spread messages about prevention, the dangers of today's cocaine, where to get help and the need for every drug user to carry naloxone.

The group also has a "quick response team" including police, emergency workers and addiction specialists who follow up with overdose victims, often going to their homes to try to get them into treatment.

That treatment needs to be "culturally competent," Stephenson said, meaning providers respect diversity and the cultural factors that can affect health. These are key goals of the Urban Minority Alcoholism and Drug Abuse Outreach Program, where she works.

Barton said treatment she gets through this program is helping keep her sober and productive. She works as a cook in nearby Covington, Ky., and also tries to help friends still struggling on the streets.

Lately, she's been especially worried about one friend, a longtime cocaine user who has overdosed repeatedly and landed in the hospital.

She pleads with him to be careful, delivering a dire warning:

"One day, you're just not gonna come back."

 
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NCA Officers seizing £60 million worth of cocaine on a yacht off the Welsh coast.

Europe becomes cocaine exporter as countries struggle with overflow of the drug*

by John Walsh and William Cohn | The Telegraph | 30 Nov 2019

European countries have become so saturated with cocaine that the region has now become a hub for exporting the drug to markets such as Australia, Turkey and Russia, according to new data.

Record levels of production of the drug in South America and new smuggling routes opening up into the continent means that Europe is now a transit area for the export of cocaine.

The phenomenon is outlined in a new Europol analysis of the drug market, and comes after Spain seized a submarine carrying cocaine from Colombia in a European first this week. New trafficking routes are also being developed through war-torn west African states.

Les Fiander, one of the authors of the 2019 Drugs Market Report, said there were a number of reasons why South American production has soared in recent years.

“Organised crime groups have been able to expand their production, because authorities in source countries are not able to use anymore pesticides to fight it."




He added that the ongoing peace process in Colombia is another factor, as the vacuum left by the Farc has been rapidly filled by coca farmers looking to make quick money.

According to the report, Belgium, the Netherlands and Spain remain main entry points and distribution hubs for cocaine in the EU. Smuggling operations are becoming more sophisticated and harder to detect.

The European Union’s law enforcement agency’s 2019 Drugs Market Report, shows that the value of the drugs trade in Europe is roughly €30 billion. Cannabis, accounting for 39% of the total market, is the most consumed illicit drug followed by cocaine at 31%. It is estimated that four million European citizens use cocaine.

Last week's submarine was carrying three tonnes of cocaine valued at €100 million when it was detained off the north-west coast of Spain. The submarine had travelled from South America and it is believed the cocaine was destined for the British market.

West and North Africa appears to be emerging as a more significant transit point for both air and maritime shipments of cocaine destined for the European and possibly other markets.

The report found that heroin production, mainly in Afghanistan, is also on the rise and consequently there is likely to be a much greater availability of the drug in Europe over the coming years.

The use of heroin and other opioids still accounts for the largest share of drug-related harms. The retail value of the heroin market in 2017 was estimated to be at least €7.4 billion.

*From the article here:

 
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African psychedelic ibogaine a drug of last resort*

by Tyler Nyquvest | SCMP | 26 Dec 2019

After moving to New York at the tender age of 18, fashion model Shea Prueger quickly found herself caught up in that city’s drug-fuelled party scene.

“I never intended to become physically and psychologically dependent on opiates – I don’t think anyone sets out for that – but it happened,” recounts Prueger.

Her drug use started with cocaine, and led Prueger to acquire prescriptions for oxycodone for a series of unexplained migraines, then moved on to street opiates, and finally heroin. After being treated in hospital in London and cycling through several rounds of suboxone and methadone treatments – opioids used to help in detoxification – she believed nothing would work. Then her boyfriend told her about ibogaine.

Now, after nearly a decade of using the powdered root of the iboga plant, Prueger is clean and healthy, providing ibogaine treatments for others and splitting her time between treatment facilities in Asia and Costa Rica. So what is ibogaine?

Iboga is a shrub that is typically found in the Congo Basin in the Central West African rainforest.

According to Trevor Millar, owner of Liberty Root Therapy in Vancouver, Canada, ibogaine is used in a number of treatments – including as an aid to psychotherapy and in the treatment of substance abuse disorder, particularly opioid abuse. Iboga is used in initiation ceremonies in Gabon and other parts of West Africa that follow the Bwiti spiritual tradition.

“Treatment protocols around the world vary, and it’s been used ceremonially for centuries, but in 1962 someone who was addicted to heroin tried ibogaine and after his experience, he realised he wasn’t craving heroin, nor had he experienced the painful withdrawal symptoms normally associated with stopping heroin use,” Millar says.

That someone was Howard Lotsof, the founder of GITA, the not-for-profit corporation supporting the sacramental and therapeutic uses of iboga and its various strains through awareness, scientific research, medical conferences and more.

“That was when ibogaine’s anti-addictive properties were discovered and it has been used in this regard ever since, both underground and in clinics within countries where ibogaine is not illegal.”



Experts have been surprised by ibogaine’s ability to significantly lessen or nearly eliminate the withdrawal phase of addiction recovery, which is typically an extremely painful part of the process and the part where most recovery attempts fail.

In a 2017 study published in The American Journal of Drug and Alcohol Abuse, 30 subjects with opioid dependency who were users of oxycodone and/or heroin received a calculated dose of ibogaine over 12 months. After one month, half of participants reported no relapse into drug use. Study participants were followed up every two to four months; the study ended at 12 months and did not show any improvement above 50 per cent.

The study concluded that “ibogaine was associated with substantive effects on opioid withdrawal symptoms and drug use in subjects for whom other treatments had been unsuccessful, and may provide a useful prototype for discovery and development of innovative pharmacotherapy of ‘addiction.’”

The results of another study in The American Journal of Drug and Alcohol Abuse, done in conjunction with medical providers in New Zealand, showed that “a single ibogaine treatment reduced opioid withdrawal symptoms and achieved opioid cessation or sustained reduced use in dependent individuals as measured over 12 months.”

Still, ibogaine is a contentious substance. The slim body of research that exists on ibogaine also indicates treatments can be dangerous, even deadly. Britain’s Royal College of Psychiatrists has reported several ibogaine deaths, but admits that, because of the treatment’s underground nature, it is hard to know just how many.

Ibogaine works in part by slowing the heartbeat, which makes it dangerous for some drug users, and those with pre-existing heart conditions. Dosage is difficult to prescribe, as its impact can vary widely among users. Ibogaine also induces intense psychedelic episodes that can last for a number of hours; these can be difficult to process, and even overwhelming.

Prueger encountered this experience first-hand, and calls the episode, and ibogaine itself, ineffable. In her first treatment, she entered a dreamlike state in which she saw thunderstorms, purple clouds, trains and much more. While she admits to the intensity of the visions or “trip,” Prueger also acknowledges the power ibogaine had on her recovery path.

According to Dr Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation in the US state of Minnesota, treatment for addiction recovery has changed dramatically over the years.

“Historically, people would come into a residential setting like one of our own and stay for four weeks and then return home to outpatient therapy or 12-step meetings,” says Seppala.

“There has been a recognition over the last 20 years that addiction is a chronic illness and you don’t treat most chronic illnesses with subacute medical care for a month … you follow people long term and ensure there is long-term stability.”

The foundation, founded in 1949, is the largest non-profit treatment provider in the United States and one of the most widely recognised addiction treatment facilities in North America. The foundation does not provide ibogaine or any kind of experimental therapy.

Seppala says that he has heard of and followed news on ibogaine for some time, and echoes medical professionals’ concerns over its use. He notes that psychiatric illnesses that are complicated by multiple types of substance abuse are becoming more commonplace.

This makes recovery far more complex, requiring multiple layers of care. Even conservative establishments such as Betty Ford are researching new ways to help those suffering from addiction.

Laws governing ibogaine possession and use vary.

In Costa Rica, Central America, where many treatments take place in rented rooms, ibogaine’s use in medicine is illegal, but it is not illegal for an individual to possess it. In New Zealand, Mexico, Canada, the Netherlands, South Africa and Asia, independent ibogaine treatment clinics operate in a legal grey area, and offer various treatments.

At her facility in Thailand, Prueger sees requests from people from South Asia to the United States.

She has no formal medical training but has shadowed doctors and nurses and taken courses in the Philippines, as there are few opportunities to get involved. Money, marketing and support remain large barriers.

For those who have tried ibogaine, the consensus is largely consistent.

“I really believe in the power that iboga and ibogaine have,” says Prueger. “It’s a beautiful thing, and in terms of how much of it we understand, there is still so much to learn.” And that has only heightened her interest.

*From the article here:

 
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"By inducing antibody responses which block the activity of the drug, we are able to prevent the high
associated with using cocaine,"
says study author Herman Staats.

Vaccine blocks cocaine high

by Sarah Avery | FUTURITY | 5 Feb 2020

Adding an ingredient to an existing cocaine vaccine appears to enhance its effectiveness in blocking the drug’s high.

The vaccine, which is a liquid nose drop rather than needle injection, includes a new compound that helps the immune systems create antibody responses against cocaine.

While researchers have only tested the new formulation of the vaccine in mice, it shows promise for human populations, says senior author Herman Staats, professor in the department of pathology and associate professor of immunology and medicine at the Duke University School of Medicine.

By inducing antibody responses which block the activity of the drugs, we are able to prevent the euphoria or high that is associated with using the cocaine,” says Staats, who is also a member of the Duke Human Vaccine Institute.

If addicted individuals don't get this ‘high’ from using the drug, they may be better able to remain in treatment programs that help them recover from their addiction.”

Staats and colleagues compared the movements of mice that had received cocaine with those that had received cocaine and the vaccine to determine the effects of the dosage. Vaccinated mice showed less movement, which correlates to a decreased “high” in humans.

Cocaine is one of the most potent and addictive psycho-stimulants and there are no available drug therapies to treat addiction. The drug crosses the blood-brain barrier, enters the brain, and exerts its effects upon the central nervous system.

An estimated 2.2 million people in the United States were users of cocaine, according to the 2017 National Survey on Drug Use and Health prepared by the Substance Abuse and Mental Health Services Administration.

A group of researchers at Duke and RTI International, are also investigating how they could use a vaccine approach to treat opioid addiction.

The findings appear in npj Vaccines.

 
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CBD a ‘promising’ therapy in treating cocaine dependence

by Kyle Jaeger | 16 Jul 2020

A key component of cannabis shows promise in the treatment of cocaine misuse, according to a new meta-study.

Scientists analyzed 14 studies from the past five years on the administration of CBD in animal subjects consuming cocaine, and determined that the non-intoxicating ingredient appears to have a multitude of effects that mitigate addictive behaviors.

“CBD promotes reduction on cocaine self-administration. Also, it interferes in cocaine induce brain reward stimulation and dopamine release,” the study, published this month in the journal Pharmacology Biochemistry and Behavior, states. “CBD promotes alteration in contextual memory associated with cocaine and in the neuroadaptations, hepatotoxicity and seizures induced by cocaine.”

“CBD is a promising adjunct therapy for the treatment of cocaine dependence.”

While not all of the studies under review were consistent with one another, and the researchers emphasized the need for human trials, they said that animal research has generally indicated CBD can reduce self-administration of cocaine and many symptoms of addiction.

For example, a 2018 study found that a 20 mg/kg daily dose of cannabidiol led to a “significant difference in the consumption of [cocaine] on the 10th day of the study and lower consumption throughout the entire procedure compared to the control group.”

In 2019, researchers similarly reported that “the systemic administration of CBD (20 mg/kg) 30 minutes before testing significantly reduced the self-administration of low doses of cocaine.” The effect did not occur with lower concentrations of CBD, however.

Another study that was analyzed showed that "10 and 20mg/kg CBD doses significantly increased the threshold for self-stimulation, suggesting a reduction in the brain-stimulation reward,” which is a major component of addiction.

Rat subjects with a history of cocaine use that were treated with the cannabis compound also exhibited less anxiety, according to another study. That was “evidenced by the greater time spent in the open arms of the elevated plus maze.”

“The evidence described in the present systematic review indicates that CBD is a promising adjunct therapy for the treatment of cocaine dependence due to its effect on cocaine consumption, brain reward, anxiety, related contextual memories, neuroadaptations and hepatic protection as well as its anticonvulsant effect and safety,” the study authors concluded.

“The clinical administration of CBD leads to a reduction in the self-administration of cocaine and, consequently, the amount of the drug consumed. Moreover, the reward induced by cocaine is blunted by CBD treatment.”

“Among the other findings of the present literature review, neuroadaptations promoted by cocaine were attenuated; contextual memory associated with cocaine was reduced; anxiety related to cocaine consumption was reduced; and hepatotoxicity and seizures associated with cocaine use were reduced when animals were treated with CBD. Considering the low toxicity, the absence of severe side effects and the reduction of cocaine-related behavior, CBD is a promising adjuvant in treatment processes for individuals with problems related to cocaine use.”


 
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Ibogaine is an indole alkaloid, isolated from the root bark of the African tree Tabernanthe Iboga, known to cause Long QT Syndrome (LQTS) — a dangerous condition that can lead to cardiac arrhythmia and death. But the risk is manageable. Dr. Bruno Chaves is an expert in treating cocaine addiction with ibogaine. He has performed over 1200 treatments with ibogaine in hospital without a single adverse event. 62% of those treated remain abstinent long term. Dr. Chaves is currently accepting new patients for treatment in hospital in São Paulo. For more information, contact Dr. Chaves directly : [email protected]

 

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Overdose deaths from cocaine rising dramatically

by Steven Reinberg | Medical Xpress | 7 Oct 2020

While opioids were grabbing the headlines, cocaine overdose deaths in the US have marched upward, nearly tripling over five years, a new government report shows.

"After a period of stability, cocaine-induced deaths rose by about 27% per year, on average, from 2013 through 2018," researchers at the U.S. Centers for Disease Control and Prevention said.

"While much attention has been given to the increase in drug overdose deaths involving opioids, it's also important to recognize that deaths involving other drugs, such as cocaine, have also increased in recent years," said Dr. Holly Hedegaard, lead researcher and injury epidemiologist at the CDC's National Center for Health Statistics (NCHS).

In 2018, those most likely to die from cocaine were men, adults aged 35 to 44, Black people and city dwellers in the Northeast. "Knowing who's most vulnerable can help in forming prevention strategies," Hedegaard said.

Given this alarming rise, "focused efforts are needed to better understand why the rate of drug overdose deaths involving cocaine has tripled in recent years," she said.

According to the report:​
  • Cocaine overdose deaths were stable from 2009 to 2013, but by 2018 had jumped from about two to nearly five per 100,000 people.​
  • Americans aged 35 to 44 were most likely to die of a cocaine overdose in 2018. Those 65 and over were least vulnerable.​
  • In 2018, Black people had nearly double the rate of cocaine-related deaths compared to white people, and three times that of Hispanics at nine per 100,000 versus five and three, respectively.​
  • The rate of cocaine deaths in 2018 was nine times higher in Northeast urban counties than in Western rural counties.​
Pat Aussem, associate vice president at the Partnership to End Addiction, said several factors may have contributed to the dramatic rise in cocaine overdose deaths.

"In recent years, countries like Colombia have had bumper crops of coca, and the prices of cocaine have fallen dramatically, resulting in a cheap, abundant product for export. With its increase in purity and decrease in price, cocaine can be a less expensive alternative to prescription stimulants like Ritalin and Adderall," Aussem said.

"Cocaine is also often laced with fentanyl, a powerful synthetic opioid, which significantly increases the probability of an overdose," she noted.

Indeed, the report found that between 2014 and 2018, the rate of drug overdose deaths from cocaine plus opioids increased faster than the rate of cocaine deaths without opioids.

"When mixing cocaine and opioids intentionally, the desired result is to experience the high of cocaine while easing its after-effects with the depressant qualities of an opioid," Aussem explained. "If the person using the drug is unaware that the cocaine they are consuming is laced with fentanyl and lacks a tolerance for opioids, they are more likely to experience an adverse reaction or an overdose."

Cities have been the centers of the cocaine epidemic, Aussem said. "Historically, urban areas such as New York and Miami have been key markets for the cocaine suppliers and are notably along ports of entry. Urban markets have also been plagued by fentanyl, which is being used to cut cocaine," she said.

"For urban Black people, the greater purity, lower price and widespread availability of cocaine may make it more attractive to use than other stimulants," she said. "This may account for the alarming increase in fatalities noted in the report amongst different subgroups," Aussem suggested.

A comprehensive strategy to address addiction is necessary to reverse this trend, she noted.

"That includes prevention, treatment and recovery supports," Aussem explained. People need affordable access to evidence-based care that includes mental and physical health needs, housing supports, employment and more, she said.

"Also, proven pharmacological interventions are needed to complement behavioral strategies," she added, noting that trials of anti-addiction medications and even a vaccine are under way.

Cocaine users should also be educated on the risks of the drug being cut with fentanyl. "Using fentanyl test strips and having naloxone on hand are additional safety measures that could help reduce overdose deaths," Aussem said, referring to the overdose treatment marketed as Narcan.

 
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mr peabody

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Fentanyl is linked to thousands of urban overdose deaths.

Surge in cocaine mixed with fentanyl has communities and law enforcement on edge

by Marc Nathanson | ABC News

The fear was the worst part for Ryan Fowler.

The New Hampshire native spent 10 years addicted to heroin, which has been increasingly mixed with the synthetic opioid fentanyl to boost its potency.

"I was full of a lot of fear, doubt and insecurity, and I didn't know how to cope with it, so when I found drugs it was my solution," Fowler told ABC News. "The anxiety I didn't have language for went away. So drugs were my solution -- until they really turned on me."

Three times, Fowler said he nearly died from overdoses, only to be revived each time by emergency responders. Authorities say fentanyl has been driving opioid overdose rates for years, and now they're facing a new challenge as fentanyl shows up more and more in another popular drug: cocaine.

"Cocaine, New York's nemesis of the 90s, is back -- indicating traffickers' push to build an emerging customer base of users mixing cocaine with fentanyl," DEA Special Agent in Charge Ray Donovan told ABC News in March, after officials seized $77 million worth of cocaine at the Port of New York and New Jersey.

Officials say they're seeing more fentanyl in cocaine because drug traffickers are looking for ways to make cocaine more attractive, which they need to do because a surplus of coca plants in Colombia has resulted in an overabundance in the marketplace.

The cocaine seizure in New York in March, the biggest there in 25 years, was dwarfed last week by the seizure of more than $1 billion worth of cocaine on a cargo ship passing through Philadelphia on its way from Chile to Europe. The historic bust, one of the largest in U.S. history, comes amid a series of large drug seizures in the Northeast.

Some 38,000 pounds of cocaine had been seized from Oct. 1 to May 31, 2019, compared with nearly 52,000 pounds over the entire previous fiscal year, according to Customs and Border Protection.

And in April, for instance, the DEA confiscated more than 100 pounds of suspected cocaine and fentanyl in a truckload of Tupperware in New Jersey.

The increasing presence of fentanyl in cocaine is the latest twist in a public health crisis that's pushed U.S. overdose rates to record levels. Whether consumed alone or in combination with other drugs, fentanyl has topped the list of the nation's deadliest drugs for the third year in a row, causing the rate of drug overdose deaths to more than quadruple since 1999.

Since 2014, synthetic opioids like fentanyl in combination with cocaine have caused an even greater surge in overdose deaths, according to the National Institute on Drug Abuse.

Today, Fowler, who's been drug-free for four years, helps others combat addiction as a community engagement specialist for the Doorway program at New Hampshire's Granite Pathways, a social services organization located in the state that many see as ground zero in the opioid epidemic. But the 29-year-old knows that the popularity of fentanyl means he's facing an uphill battle.

"It's a really acute opioid," he said of the synthetic drug, which scientists say is up to 100 times more powerful than morphine. "You can spend a couple hundred dollars on the internet and order a gram of pure fentanyl and turn that into tens of thousands of dollars really quickly -- and in the process, kill people unknowingly."

That's because a tiny amount of fentanyl can boost a drug's potency to deadly levels, according to authorities.

In a 2018 bulletin, the DEA noted a 112% increase in the presence of cocaine and fentanyl together in drug samples and a decrease in fentanyl/heroin combination. And of those cocaine samples, 59% also contained heroin.



"This determination supports the theory that increased cocaine supply without corresponding consumer demand may result in cocaine being used as an adulterant to the existing heroin supply, with or without the knowledge of the seller or buyer," the report said.

A DEA report from Florida in the same year said that "deadly" contaminated cocaine was "widespread" in the state.

"The widespread seizures of contaminated cocaine indicate that drug dealers are commonly mixing fentanyl and fentanyl-related substances into the drug (cocaine)," the report said. "In some cases, this is done purposefully to increase the drug's potency or profitability (and customer base). In other cases, fentanyl is inadvertently mixed into cocaine by drug dealers using the same blending equipment to cut various types of drugs, such as heroin."

The biggest risk comes to those who use cocaine only occasionally, the report said.

"Sometimes, if people who occasionally use cocaine are not opioid users, they're really at increased risk for an overdose because they're what we call 'opioid naive' -- they have no tolerance,"
Dr. Denise Paone, of the New York City Department of Health, told ABC News.

In 2017, fentanyl was New York City's deadliest drug, identified in 57% of the city's overdose deaths, Health Department figures show.

As a result, this month the department is running the latest in a series of public health campaigns to warn drug users of the dangers of mixing fentanyl with other drugs. The $730,000 campaign is using outdoor media and online ads to encourage users to avoid mixing drugs and avoid using drugs without others present. It also encourages users to carry the opioid-blocking drug naloxone, which could reverse a potentially fatal overdose.

"We're providing messaging about the presence of fentanyl cut into various substances, including cocaine," Paone said of the campaign, which follows similar efforts in 2017 and 2018. The city also distributed more than 100,000 naloxone kits last year.

The greatest danger, Paone said, often comes when fentanyl is present without the user's knowledge.

"Fentanyl is so potent, and it's really hard for someone to tell if it's in the substance they intend to use," Paone added. "This really is a crisis."

That's why last year Fowler spearheaded a campaign through Safe Harbor Recovery Center to provide free fentanyl testing strips to users around Seacoast, New Hampshire. When a user mixes a tiny amount of their drug with water, then dips a test strip into the mixture, the strip will indicate whether fentanyl is present.

"The cool part about providing people with the ability to test their drugs for what's in them is that it regulates the drug market really, really quickly," Fowler said. "If you can go back to the person who's selling to you and say 'Hey, this has fentanyl in it, and I don't want that stuff,' it kind of sorts itself out like any economy would. It's like you and I would go to a store and look at a label and say, 'I don't want high fructose corn syrup, so I'm not going to buy this product, I'm going to buy this other product.'"

For Fowler, education is part of a wider approach to combating drug addiction that includes treatment and counseling. "With more than 50,000 overdose deaths in the U.S. each of the last three years, the fight," Fowler said, "has never been more important."

"I'm sitting here watching friends die preventable deaths,"
he added. "It's really frustrating."

 
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mr peabody

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Brazilian doctor, Bruno Rasmussen, on treating cocaine addiction with ibogaine*

Interesting interview segment with a Brazilian Iboga researcher Bruno Rasmussen. The article is translated into English.

The R7 interviewed physician and researcher Dr. Bruno Rasmussen on the advances in research and details of stimulent addiction treatment with ibogaine. Ramussen also gives an overview of psychedelic medicine.

How long have you been researching and participating in research groups for a chemical dependency treatment?

For 23 years, but independently. Together with other researchers, since 2012.

When did you start your studies with psychedelic medicine?

The most important academic studies, related to ibogaine, began in 2012, through a team composed by psychiatrist Dartiu Xavier, from PROAD of UNIFESP; Eduardo Schenberg, neuroscientist; Maria Angelica Comis, psychologist; And I, a clinical doctor. This study was published in 2014 in the Journal of Psychopharmacology.

What are the results?

At that time patients who had taken ibogaine for chemical dependence from 2005 to 2013 were interviewed and followed up, and a result of 62% of abstinent patients after treatment was reached. In addition, we observed that ibogaine, applied within the appropriate clinical safety standards, in a hospital environment, is effective and safe, with no significant adverse events.

These results also led to the publication of statements from the Coned-SP (State Council on Drug Policies of the State of Sao Paulo text below) that stipulated that treatment with ibogaine must necessarily be performed in a hospital environment, with medical, psychiatric and psychological follow-up.

Have there been other advances?

After that, we did another research, a qualitative study, with the participation of the psychiatrist Luis Fernando Tofoli, from Unicamp, and Joao Felipe Alexandre, from UFABC, who showed a great improvement in the quality of life After treatment with ibogaine, even in patients who came to relapse, with shorter and less profound episodes of relapse. This second study was published now in April 2017 in the Journal of Psychedelic Studies. We also have a third study, from the same team, on the same subject, which is in the process of being published, which shows similar results.

Regarding MDMA, I participate in another group that is undergoing training to conduct research on substance use in people with PTSD. This research is occurring in a coordinated way in other parts of the world, especially in the United States, and should begin here in Brazil in the coming months.

Other studies, with Ayahuasca, have been conducted at USP in Ribeirao Preto and UFRN, for depression, and have occurred in recent years as well. But I have no connection with the latter.

Which substances are already under study in Brazil?

In terms of psychedelic medicine, Ayahuasca, for depression; Ibogaine, for chemical dependence; And MDMA, for posttraumatic stress disorder. Brazil has been strong in this type of research, as was clear at the MAPS (Multidisciplinary Association for Psychedelic Studies) conference held last April in Oakland, attended by more than 3,000 people, where several lectures were from Brazilians, including me.

How do you evaluate the outcome in the volunteer group?

Regarding ibogaine, I evaluate the results as excellent. No current approach offers comparable results and, interestingly, in such a short time, since most patients taking ibogaine require only one dose, which is applied during a 24-hour hospital stay.

As for Ayahuasca and depression, great results too, and with the same characteristic, very fast results. Regarding MDMA, in Brazil the research is still in the initial phase, but I was able to follow some patients who did this treatment in the USA, for post-traumatic stress (in this case, veterans), and the results were also very good. In 82% of cases, after 3 sessions the patients no longer met the criteria for the disorder.

How long does conventional chemotherapy treatment take without ibogaine?

A few months, most often about 9 months, with a relapse rate greater than 70%.

In the case of Ibogaine, specifically, how is the procedure in Anvisa to allow the medicinal use of the plant?

Well, in the case of ibogaine, the use of the plant in nature, although it is the traditional way of using it, is not so interesting, since innumerable variables (plant type, soil, climate, mode and time of Influence purity and result.

Therefore, it is safer and with more predictable results if the extracted and purified substance, which is called ibogaine HCL, is used. This substance, although not yet registered with Anvisa, may be imported for personal, non-commercial use, by the patient's own initiative, according to Decree 8.077 of August 2013 and Anvisa Resolution 28/2011.

In order to avoid the bureaucracy of this importation process, it would be important for the medication to be registered in Brazil, which is a long and bureaucratic process, but I am confident that this will happen in the medium term, since this process is already under way.

How does Ibogaine work in the treatment of chemical dependence?

Ibogaine increases the manufacture, by brain cells called glial cells, of a factor called GDNF (Glial Cell-Derived Neurotrophic Factor). It is considered a neuronal growth factor, which causes the neurons to proliferate and connect or reconnect with each other. This effect apparently rebalances the neurotransmitters (dopamine, serotonin) and brings a sense of sustained well-being, which decreases the patient's need for drug use.

In addition, during the effect of ibogaine, the patient enters a state called onirophrenia, which is the daydream, a moment of expansion of consciousness in which the person can re-evaluate attitudes, feelings, where he has insights related to his problems.

This ends up functioning as an intensive, concentrated, drug-induced "psychotherapy" and is very effective in increasing the patient's understanding of the problem he is facing.

Is the patient at risk of becoming a chemical dependent of ibogaine?

No, the experience with ibogaine is not pleasant, it does not give pleasure, there is no reported case of use of ibogaine for recreation purposes.

Are there different levels of crack dependents? In your research have you already detected any profile of controlled use of crack or in all cases the user ends up falling into a severe dependency after a period of crack use?

In relation to any drug, including alcohol, there are always patients who abuse more than others, and also always have people who can make a use less harmful or more controlled. This also happens in relation to crack. But it is less common than with regard to cocaine or alcohol for example. But it's not all crack users who have seen zombies as is believed.

There are many cases of relapse and multiple hospitalizations of dependents. With psychedelic medicine, is the risk of relapse lower? Is a long period of hospitalization necessary for treatment with psychedelic medicine having the necessary effect?

That's the great advantage of psychedelic medicine, it's the response time. Always very fast, in one or at most a few sessions, you can already see the result. In the case of ibogaine, as I have said, most of the time, it is a single dose. And the hospitalization is necessary for a very short period, only during the application of the medicine.

Some patients may require a 30-day hospitalization period prior to application to better prepare for withdrawal of certain medications that should be discontinued prior to taking ibogaine and other Undesirable drug interactions. But this hospitalization period will always be much shorter than in traditional treatments. And that is what makes the industry of clinical dependence not like ibogaine, and spreads misrepresented information, because commercially it does not interest a drug that decreases the length of stay.

In addition, as the second study shows, relapses after ibogaine are shorter, deeper and with a faster recovery from normal life.

The Spanish psychologist Genis On, who also studies psychedelic medicine, talks about the importance of a psychotherapeutic process to accompany the treatment and that the use of psychedelic substances act as a coadjuvant and not as a main treatment. What do you think this is and what should be the preparation and evaluation of the patient before starting treatment.

I agree with him 100%. Ibogaine and other substances can be considered as facilitators of psychotherapy and, without it, there is nothing to be facilitated, so efficacy drops a lot. Ibogaine is not a miracle, it is a tool that along with other procedures, increases the chance of the patient returning to a normal life. But there is no point in reaching and taking ibogaine without proper monitoring, the result will be frustrating.

How would this adequate monitoring be?

The preparation should consist of some consultations with a psychotherapist, to explain to the patient what will happen during the experience, to adjust the person's expectations to reality, and to diagnose any comorbidities (diseases that the person may present, of dependence), which may be contraindications to treatment (e.g. schizophrenia). And after the shot, a follow-up is also important, to help one digest the experience and prepare to resume normal life.

In addition, a medical evaluation is also important to make sure that the patient has no heart, kidney, liver disease, which could compromise the safety or efficacy of the medication.

*From the article here :
http://iboga.io/brasileiros-estudam-...ontra-o-crack/

Dr. Chaves has performed over 1200 treatments with ibogaine in hospital without a single adverse event. 62% of those treated remain abstinent long term. Dr. Chaves is currently accepting new patients for treatment in hospital in São Paulo, Brazil. For more information, contact Dr. Chaves directly : [email protected] -pb
 
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"The public needs to know that today's cocaine contains fentanyl"*

by Justin Herdman

Socrates Kokkalis came to Cleveland last year for several business meetings. When the meetings were over, Kokkalis ate dinner with colleagues then visited the casino downtown. He also made a series of quick phone calls seeking cocaine, which he ultimately purchased from a dealer.

Kokkalis then went to his room on the hotel’s 24th floor, but he never came out. He died on his hotel room floor, apparently unaware the cocaine he bought actually included fentanyl, a lethal opioid that is up to 40 times more potent than heroin.

The story of Socrates Kokkalis has a sad ending that is becoming all too common in Northeast Ohio. Kokkalis, the son of a Greek billionaire, is not the typical drug overdose victim in Cleveland. But the method of his death – ingestion of cocaine laced with fentanyl – is now the signature killer for an overdose crisis that has entered a new phase.

Ohio has been on the front lines of the nation’s opioid epidemic for more than a decade, going back to pill mills flooding our streets with prescription painkillers. Pills gave way to heroin, which was cheaper and became more easily available, and heroin was eventually cut with fentanyl, a more powerful, and still cheaper, synthetic opioid made not from poppies but from chemicals in labs in China and Mexico.

At each stage of this crisis, deaths have risen precipitously as the substances became more potent and easily available. Now this epidemic has changed again. Heroin is now hard to find. Instead, we are in the midst of a surge in deaths from cocaine, either alone or mixed with fentanyl. Among cocaine’s effects on the body is to speed the heart. When mixed with fentanyl, which depresses breathing, the result is life threatening. Even a very small dose of fentanyl can kill a human being.

Last year was the first time since the start of this crisis that Cuyahoga County saw more people die from cocaine than heroin. So far in 2019, more than 60 percent of overdose deaths in Cuyahoga County are associated with cocaine, either as a stand-alone narcotic or mixed with fentanyl.

This trend is changing the demographics of who is dying. Victims from cocaine-associated overdoses span several generations, from ages 19 to 71. Many of those dying, however, are in their 50s and 60s.



So why is this happening? And what can we do about it?

There are a number of reasons why fentanyl may be mixed with cocaine. Some believe dealers are intentionally mixing fentanyl with cocaine to create a new market of opioid addicts. Another possibility is the narcotic effect of combining cocaine and fentanyl drives user demand. We also cannot discount instances where neighborhood drug dealers simply sell whatever is available that will turn a profit, or may be working in an unsanitary environment with multiple drugs.

We do know the cocaine being intercepted at our borders typically arrives unmixed with fentanyl, so this cross-contamination is likely happening closer to the street level.

This month, the community group Greater Than Heroin, advertising agency Marcus Thomas, our office and others are launching a public awareness campaign to warn everyone that they should operate under the assumption that the drugs they buy on the street contain fentanyl. Separate efforts continue to make free fentanyl test strips and the opioid antidote Narcan more readily available.

Let’s be clear: There is no safe amount to try recreationally. In fact, our office filed a record number of indictments last year against the people who bring drugs into Ohio and seek to profit from this wave of death and broken lives, including bringing federal charges against the man who sold Socrates Kokkalis the fentanyl-laced cocaine.

Yet we also have to acknowledge the opioid crisis has set its sights on a new group of victims, those who use cocaine and crack-cocaine, with absolutely no idea that the mistake they are making may be the last mistake they ever make. The scourge of addiction in our communities presents many problems for families, law enforcement and the criminal justice system. In the age of fentanyl, it may also be an automatic death sentence.

*From the article here :
 

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Geneticists Trudy Mackay and Robert Anholt’s collaborative research found cocaine use elicits rapid, widespread changes
in gene expression throughout the fruit fly brain – and that the differences are more pronounced in males than females.
Cocaine’s effect on the brain

Clemson University | Neuroscience News | 25 May 2021

Study reveals a specific cell cluster in the brains of drosophila flies that are affected by acute cocaine exposure. The findings could help with the development of treatments to prevent addiction in humans.

New research from the Clemson University Center for Human Genetics has identified specific cell clusters in the brain of the common fruit fly affected by acute cocaine exposure, potentially laying the groundwork for the development of drugs to treat or prevent addiction in humans.

While cocaine’s neurological effects are well known, the underlying genetic sensitivity to the drug’s effects is not. In human populations, susceptibility to the effects of cocaine varies due to both environmental and genetic factors, making it challenging to study. Approximately 70 percent of genes in the fruit fly, Drosophila melanogaster, have human counterparts, providing researchers with a comparable model when studying complex genetic traits.

Geneticists Trudy Mackay and Robert Anholt’s collaborative research found cocaine use elicits rapid, widespread changes in gene expression throughout the fruit fly brain – and that the differences are more pronounced in males than females.

Flies exposed to cocaine showed impaired locomotor activity and increased seizures. The study showed all types of fly brain cells were affected, especially Kenyon cells in the fly brain’s mushroom bodies and some glia cells. Mushroom bodies, which get their name because they look like a pair of mushrooms, are integrative brain centers that are associated with experience-dependent behavioral modifications.

These findings could eventually lead to therapeutics.
“This research identifies the regions of the brain which are important,” said Mackay, the Self Family Endowed Chair in Human Genetics.

“Now, we can see what genes are expressed when exposed to cocaine and whether there are Federal Drug Administration-approved drugs that could be tested, perhaps first in the fly model. We’ve already spotted several of these genes. This is a baseline. We can now leverage this work to understand potential therapy.”

THE RESEARCH

In the study, male and female flies were allowed to ingest a fixed amount of sucrose or sucrose supplemented with cocaine over no more than two hours.

Researchers observed their behavior after cocaine ingestion and found evidence that exposure to cocaine results in physiological and behavioral effects, including seizures and compulsive grooming.

To assess the effects of cocaine consumption on brain gene expression, the researchers dissected the fly brains and dissociated them into single cells. The researchers used next-generation sequencing technology to make libraries of the expressed genes for individual cells. Each cell has thousands of transcripts.

Through sophisticated statistical analysis, the researchers could group them into 36 distinct cell clusters. Annotation of clusters based on their gene markers revealed that all major cell types – neuronal and glial – as well as neurotransmitter types from most brain regions, including mushroom bodies, were represented.

“We found the effects of cocaine in the brain are very widespread, and there are distinct differences between males and females. There is substantial sexual dimorphism,” said Anholt, Provost’s Distinguished Professor of Genetics and Biochemistry. “We built an atlas of sexually dimorphic cocaine-modulated gene expression in a model brain, which can serve as a resource for the research community.”

ULTRA-POWERFUL

The single-cell technique is ultra-powerful and offers impressive advantages over standard gene expression profile studies.

“If an entire brain is used and there’s heterogeneity of gene expression, such that it’s up in one cell and down in another, you don’t see any signal. But with the single cell analysis, we’re able to capture those very, very fine details that reflect heterogeneity in gene expression among different cell types. It is very exciting to apply this advanced technology here at the CHG,” Mackay explained.

Mackay is one of the world’s leading authorities on the genetics of complex traits. She has a longstanding interest in behavioral genetics and developing the fruit fly as a model for understanding the genetic basis of complex behaviors.

Her laboratory developed the Drosophila melanogaster Genetic Reference Panel (DGRP), which now consists of 1,000 inbred fly lines with fully sequenced genomes derived from a natural population. The DGRP allows researchers to use naturally occurring variation to examine genetic variants that contribute to susceptibility to various stressors.

 

mr peabody

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"The public needs to know that today's cocaine contains fentanyl"*

by Justin Herdman

Socrates Kokkalis came to Cleveland last year for several business meetings. When the meetings were over, Kokkalis ate dinner with colleagues then visited the casino downtown. He also made a series of quick phone calls seeking cocaine, which he ultimately purchased from a dealer.

Kokkalis then went to his room on the hotel’s 24th floor, but he never came out. He died on his hotel room floor, apparently unaware the cocaine he bought actually included fentanyl, a lethal opioid that is up to 40 times more potent than heroin.

The story of Socrates Kokkalis has a sad ending that is becoming all too common in Northeast Ohio. Kokkalis, the son of a Greek billionaire, is not the typical drug overdose victim in Cleveland. But the method of his death – ingestion of cocaine laced with fentanyl – is now the signature killer for an overdose crisis that has entered a new phase.

Ohio has been on the front lines of the nation’s opioid epidemic for more than a decade, going back to pill mills flooding our streets with prescription painkillers. Pills gave way to heroin, which was cheaper and became more easily available, and heroin was eventually cut with fentanyl, a more powerful, and still cheaper, synthetic opioid made not from poppies but from chemicals in labs in China and Mexico.

At each stage of this crisis, deaths have risen precipitously as the substances became more potent and easily available. Now this epidemic has changed again. Heroin is now hard to find. Instead, we are in the midst of a surge in deaths from cocaine, either alone or mixed with fentanyl. Among cocaine’s effects on the body is to speed the heart. When mixed with fentanyl, which depresses breathing, the result is life threatening. Even a very small dose of fentanyl can kill a human being.

Last year was the first time since the start of this crisis that Cuyahoga County saw more people die from cocaine than heroin. So far in 2019, more than 60 percent of overdose deaths in Cuyahoga County are associated with cocaine, either as a stand-alone narcotic or mixed with fentanyl.

This trend is changing the demographics of who is dying. Victims from cocaine-associated overdoses span several generations, from ages 19 to 71. Many of those dying, however, are in their 50s and 60s.



So why is this happening? And what can we do about it?

There are a number of reasons why fentanyl may be mixed with cocaine. Some believe dealers are intentionally mixing fentanyl with cocaine to create a new market of opioid addicts. Another possibility is the narcotic effect of combining cocaine and fentanyl drives user demand. We also cannot discount instances where neighborhood drug dealers simply sell whatever is available that will turn a profit, or may be working in an unsanitary environment with multiple drugs.

We do know the cocaine being intercepted at our borders typically arrives unmixed with fentanyl, so this cross-contamination is likely happening closer to the street level.

This month, the community group Greater Than Heroin, advertising agency Marcus Thomas, our office and others are launching a public awareness campaign to warn everyone that they should operate under the assumption that the drugs they buy on the street contain fentanyl. Separate efforts continue to make free fentanyl test strips and the opioid antidote Narcan more readily available.

Let’s be clear: There is no safe amount to try recreationally. In fact, our office filed a record number of indictments last year against the people who bring drugs into Ohio and seek to profit from this wave of death and broken lives, including bringing federal charges against the man who sold Socrates Kokkalis the fentanyl-laced cocaine.

Yet we also have to acknowledge the opioid crisis has set its sights on a new group of victims, those who use cocaine and crack-cocaine, with absolutely no idea that the mistake they are making may be the last mistake they ever make. The scourge of addiction in our communities presents many problems for families, law enforcement and the criminal justice system. In the age of fentanyl, it may also be an automatic death sentence.

*From the article here :
 
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