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Lying inside a scanner, the patient watched as pictures appeared one by one: A bicycle. A cupcake. Heroin. Outside, researchers tracked her brain’s reactions to the surprise sight of the drug she’d fought to kick.
Government scientists are starting to peek into the brains of people caught in the nation’s opioid epidemic, to see if medicines proven to treat addiction, like methadone, do more than ease the cravings and withdrawal. Do they also heal a brain damaged by addiction? And which one works best for which patient?
They’re fundamental questions considering that far too few of the 2 million opioid users who need anti-addiction medicine actually receive it. One reason: “People say you’re just changing one drug for another,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, who is leading that first-of-its-kind study. “The brain responds differently to these medications than to heroin. It’s not the same.”
Science has made clear that three medicines — methadone, buprenorphine and extended-release naltrexone — can effectively treat what specialists prefer to call opioid use disorder. Patients who stick with methadone or buprenorphine in particular cut their chances of death in half, according to a report by the National Academies of Sciences, Engineering and Medicine that explored how to overcome barriers to that care.
Opioid addiction changes the brain in ways that even when people quit can leave them vulnerable to relapse, changes that researchers believe lessen with long-term abstinence.
Volkow’s theory: Medication-based treatment will help those damaged neural networks start getting back to normal faster than going it alone. To prove it, she’ll need to compare brain scans from study participants like the woman who quit heroin thanks to methadone with active heroin users and people who are in earlier stages of treatment.
“Can we completely recover? I do not know that,” Volkow said. But with the medications, “you’re creating stability” in the brain, she said. And that helps recondition it to respond to everyday pleasures again.
The challenge now is finding enough people willing, and healthy enough, to have their brains scanned for science at the same time they’re struggling to quit.
Addiction is a brain disease, “not a choice, not a personality flaw, not a moral failing,” said Dr. Jody Glance, an addiction specialist at the University of Pittsburgh Medical Center, who hopes NIDA’s brain scans will help overcome some of the barriers and improve the public health response to the opioid crisis.
Not offering the medicines to someone who needs them “is like not offering insulin to someone with diabetes,” she said.
How opioids change the brain
When you sense something pleasurable — a special song, the touch of a loved one, a food like Volkow’s favorite chocolate — the brain releases a natural chemical called dopamine that essentially trains the body to remember, “I liked that, let’s do it again.”
That’s the brain’s reward system, and opioids can hijack it by triggering a surge of dopamine larger than nature ever could. Repeated opioid use overloads circuits in multiple brain regions, including those involved with learning and memory, emotion, judgment and self-control. At the same time, the brain gradually releases less dopamine in response to other things the person once found pleasurable. Eventually they seek more of the drug not to get high, but to avoid constantly feeling low.
Testing how addiction medicine helps
Volkow aims to test 80 people, a mix of untreated heroin users and patients using different medication-based treatments, inside brain scanners at the National Institutes of Health’s research hospital. Her team is measuring differences in the brain’s ability to release dopamine as treatment progresses, and how the functioning of other neural networks changes in response as study participants do various tasks.
For example, does a patient’s brain remain fixated on “cues” related to drug use — like seeing a picture of heroin — or start reacting again to normal stimuli like the sight of a cupcake?
Another test: Ask if a patient would take an offer of $50 now, or $100 if they could wait a week, checking how much motivation and self-control they can muster. “You need to be able to inhibit the urge to get something” to recover, Volkow noted. “We take for granted that people think about the future. Not when you’re addicted.”
Like in any disease, each medication may work better in certain people — because not everyone’s brain circuitry reacts exactly the same way to opioid abuse — but that hasn’t been studied. Volkow suspects buprenorphine will improve mood and emotional responses to addiction better than methadone, for instance, because of subtle differences in how each medicine works. She especially wants to test people who relapse, to try to spot any treatment differences.
Methadone and buprenorphine are weak opioids, the reason for the misperception that they substitute one addiction for another. In slightly different ways, they stimulate the dopamine system more mildly than other opioids, leveling out the jolts so there’s no high and less craving. People may use them for years. Naltrexone, in contrast, blocks any opioid effects.
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It’s a tough sell
Volkow’s team has screened more than 400 people who expressed interest in the study, but have found only about three dozen potential candidates who qualify, seven of whom have enrolled so far.
The main problem: Study participants must have no other health problem that might affect the brain’s chemistry or functioning. That rules out people who use medicines such as antidepressants, and those with a range of health conditions such as high blood pressure or diabetes.
Volkow said it’s worth the struggle to find such rare volunteers if before-and-after scans wind up showing truly different-looking brains as people get treated. “You should be able to see it with your eyes, without having to be an expert,” she said. (VOA)
As weather cleared up in Uttarakhand, Char Dham Yatra restored on Friday with more than 16,000 devotees resuming the pilgrimage from the Rishikesh camp.
According to sources, road leading to Badrinath has been repaired and helicopter service has also resumed.
Meanwhile, Uttarakhand Chief Minister Pushkar Singh Dhami visited Dungi village and met families of people who were missing after the landslip incident, and consoled them.
Dhami assured them of all possible assistance. Two people from the village are still reported to be missing.
Pilgrims were seen leaving from Rishikesh Char Dham Bus terminal and Haridwar bus station for the pilgrimage since morning.
As per the state government, various departments -- Devasthanam Board, police are assisting the pilgrims.
Police Chowki Yatra Bus Terminal, Rishikesh, was announcing passenger-information via loudspeaker.
Free RT-PCR tests of pilgrims were being conducted at Rishikesh bus terminal.
Uttarakhand Char Dham Devasthanam Management Board's media in-charge Dr Harish Gaur said pilgrimage was on in Kedarnath, Gangotri and Yamunotri, while for Kedarnath, helicopter service was also available.
Though the weather was cold in all dhams, thankfully there was no rain, he added.
Portals of the temple in Badrinath will close on November 20, Gangotri on November 5, while that of Kedarnath and Yamunotri on November 6.
Uttarakhand floods, triggered by a major downpour from October 17 to 19, have claimed 65 lives so far, 3,500 people have been rescued while 16,000 evacuated to safety.
Seventeen teams of National Disaster Response Force (NDRF), seven teams of State Disaster Response Force (SDRF), 15 companies of Provincial Armed Constabulary (PAC) and 5,000 police personnel have been engaged in rescue and relief operations.
The state has already been provided with Rs 250 crore Disaster Fund which is being used for relief works.
To prevent spread of the diseases, the Central and state governments have decided to send medical teams to the affected areas.
Snapped power lines will be restored at the earliest, the government assured.
The state government said that as soon as alert for heavy rainfall was issued, the Incident Response System was activated at state and district levels, and pilgrims were halted at safer places. (IANS/JB)
Keywords: Uttarakhand, India, Char Dham Yatra, PushkarDhami, Rishikesh.
The Centre has continued the Naga peace talks with the Isak-Muivah faction of National Socialist Council of Nagalim (NSCN-IM) leaders, but negotiations face roadblocks as the Naga leaders are adamant in their main demands for a separate Constitution and flag.
The sources aware of these developments said that the Centre was hopeful that a successful solution of the six decades-long peace talks would arrive at a logical conclusion, but in the recent statements, Naga leaders have accused the Centre of offering post-solution options.
Sources quoting the stand of Naga leaders said that NSCN's stand was loud and clear that it would not follow the forbidden route to the Naga solution that was linked to foregoing the Naga national flag and Constitution, which is the face of the Naga political struggle and identity.
The Naga leaders have also said that the Centre has been using divisive policy and flattery in the name of finding the Naga political solution when the matters heated up.
When the Centre resumed the peace process in September this year and sent the former special director of the Intelligence Bureau (IB) A.K. Mishra as the Ministry of Home Affairs' emissary to the rebel outfit's chief negotiator and general secretary T. Muivah, he assured him (Muivah) that the peace talks would be initiated under the original framework signed in 2015, a source in the Naga rebel group said.
"Here we are talking about the Naga national flag and Yehzabo (Constitution), the two issues that are holding up the Naga solution under the ongoing Indo-Naga political talks in Delhi.
"The chequered history of the Indo-Naga political issue is clear enough before us, with accords and agreements that were never meant to be implemented in letter and spirit", an important office-bearer of the rebel outfit said while criticizing the governments' stand.
Accusing the Centre, he further accused the Centre of persuading the Naga people again to accept whatever is being offered to hurry up the Naga talks.
On the invitation of the Centre, the senior leaders of the NSCN-IM including T. Muivah arrived in the national capital on October 6 this year to hold another round of talks with the Centre.
Both, the Centre and the Naga leaders had indicated their keenness on resolving this long pending issue by the end of this year in an amicable manner.
Assam Chief Minister Himanta Biswa Sharma, who is also chairman of North East Democratic Alliance (NEDA), and Nagaland Chief Minister Neiphiu Rio had been actively involved in the resumption of the peace talks and taking it forward to a logical conclusion.
Soon after the transfer of Nagaland Governor R.N. Ravi, who was appointed as the Centre's interlocutor for the Naga peace talks on August 29, 2014, to Tamil Nadu, the peace talks resumed on September 20 in Kohima when the Centre representative met the Naga leaders and invited them to visit Delhi for further rounds of peace talks.
The NSCN-IM and the other outfits entered into a ceasefire agreement with the Government of India in 1997 and over 80 rounds of negotiations with the Centre have been held in the past in successive governments. (IANS/JB)
Keywords: Nagaland, India, Constitution, Politics, Flag.
The series decider for the Test series between England and India will now be played at Edgbaston from July 1 next year, said the England and Wales Cricket Board (ECB) on Friday. India is currently leading the series 2-1 before the fifth Test at Old Trafford was cancelled hours before the start due to concerns over COVID-19 outbreak in the tourists' camp.
"The fifth match of the LV= Insurance Test Series between England Men and India Men has been rescheduled and will now take place in July 2022. The match, which was due to take place last month at Emirates Old Trafford, was called off when India were unable to field a team due to fears of a further increase in the number of Covid-19 cases inside the camp," said an ECB statement.
"With India leading the series 2-1, the concluding fifth match will now take place from July 1, 2022, at Edgbaston, following an agreement between the England and Wales Cricket Board (ECB) and the Board of Control for Cricket in India (BCCI)," added the statement.
ECB also said that due to the rescheduled Test, the white-ball series between England and India will now start six days later than originally planned. The T20I series will begin on July 7 at Ageas Bowl with Edgbaston and Trent Bridge hosting the second and third matches respectively on July 9 and 10. It will be followed by the ODI series starting on July 12 at The Oval followed by Lord's and Old Trafford hosting the second and third ODI on July 14 and 17 respectively.
"Ticket holders do not have to take any action as all tickets will remain valid for the equivalent rearranged matchday at their host venue. Host venues will communicate the new fixture details to ticket purchasers and the options available to them, including the timeframe for requesting a refund if they are not able to attend the new match day," further said the statement.
"We are very pleased that we have reached an agreement with BCCI to creating a fitting end to what has been a brilliant series so far. I'm very grateful to all the venues involved for the cooperation they've shown in allowing us to reschedule this match. I'd also like to thank Cricket South Africa for their support and understanding to allow these changes to be possible," said Tom Harrison, the CEO of the ECB.
"We would like to apologise again to fans for the disruption and disappointment of September events. We know it was a day that so many had planned long in advance. We recognise that accommodating this extra match means a tighter schedule for the white ball series. We will continue to manage our players' welfare and workloads through next year while we also continue to seek the optimum schedule for fans, players and our partners across the game."
"I am delighted that the England-India Test series will now have its rightful conclusion. The four Test matches were riveting, and we needed a fitting finale. The BCCI recognizes and respects the traditional form of the game and is also mindful of its role and obligations towards fellow Board Members. In the last two months, both BCCI and the ECB have been engaged in discussions and our efforts were aimed at finding a suitable window. I thank the ECB for their understanding and patience in finding an amicable solution," said BCCI Secretary Jay Shah. (IANS/JB)
Keywords: India, Britain, BCCI, Test Match, Cricket.