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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)
NEW DELHI - India Navy sending four ships for exercises and port visits with the Philippines, Vietnam, Singapore, Indonesia and Australia to strengthen cooperation in the Indo-Pacific region, its navy said Wednesday, as China's maritime power grows in the area.
The Indian ships will spend more than two months in the region, the navy said in a statement.
Commander Vivek Madhwal, the Indian navy spokesman, said four ships will take part.
The ships will also participate in a multilateral exercise, MALABAR-21, along with the Japanese, Australian and U.S. navies, the statement said.
It said the exercises will enhance coordination with friendly countries, based on common maritime interests and a commitment to freedom of navigation.
"Besides regular port calls, the task group will operate in conjunction with friendly navies to build military relations and develop interoperability in the conduct of maritime operations," the statement said.
The U.S., India, Japan and Australia are part of the Quad regional alliance created in response to China's growing economic and military strength. Washington has long viewed New Delhi as a key partner in efforts to blunt increasing Chinese assertiveness in the Indo-Pacific region.
India is also in a continuing standoff with China over their disputed border in the eastern Ladakh region. The countries have stationed tens of thousands of soldiers backed by artillery, tanks and fighter jets along their de facto border, called the Line of Actual Control.
Last year, 20 Indian troops died in a clash with Chinese soldiers involving clubs, stones and fists in a portion of the disputed border. China said it lost four soldiers.(VOA/HP)
The UK government on Thursday announced that it will move India from the red to the amber list on Sunday, in the country's latest update to the 'Red-Amber-Green' traffic light ratings for arrivals into England amid the Covid-19 pandemic.
This means the visit visas for the UK from India are open, in addition to other long-term visas that have remained open. But travellers from India arriving in England can complete a 10-day quarantine at home or in the place they are staying (not mandatorily quarantine in a managed hotel).
The UK government also announced that arrivals from France to England will no longer need to quarantine if they are fully vaccinated. The step aligns France with the rest of the amber list now that the proportion of beta variant cases has fallen, where those who are fully vaccinated with a vaccine authorised and administered in the UK, the US or Europe do not need to quarantine when arriving in England.
This move also simplifies the system to three categories, as well as the green watch list to give travellers notice where green status is at risk.
To continue cautiously reopening international travel, Austria, Germany, Slovenia, Slovakia, Latvia, Romania and Norway will be added to the government's green list, having demonstrated they posed a low risk to UK public health.
Besides India, Bahrain, Qatar and the UAE will also be moved from the red to the amber list, as the situation in these countries has improved.
The data for all countries will be kept under review and the government will not hesitate to take action where a country's epidemiological picture changes, a statement by the UK government said.
Following an assessment of the latest data, Georgia, La Reunion, Mayotte and Mexico will be added to the red list as they present a high public health risk to the UK from known variants of concern, known high-risk variants under investigation or as a result of very high in-country or territory prevalence of Covid-19.
Arrivals from Spain and all its islands are advised to use a PCR test as their pre-departure test wherever possible, as a precaution against the increased prevalence of the virus and variants in the country.
Transport Secretary Grant Shapps said: "We are committed to opening up international travel safely, taking advantage of the gains we've made through our successful vaccination programme, helping connect families, friends and businesses around the world.
"While we must continue to be cautious, today's changes reopen a range of different holiday destinations across the globe, which is good news for both the sector and travelling public."
Since February, anyone who arrives in the UK from a red list country has been required by law to book a stay in a managed quarantine facility for 10 days.
In order to ensure taxpayers are not subsidising the costs of staying in these facilities, which have gone up, the cost will increase from August 12. Alternative payment arrangements remain available to those who genuinely cannot afford to pay and rates remain the same for children up to 12.(IANS/HP)
A Hindu temple in Pakistan's Punjab province was reportedly vandalized by hundreds of people after a nine-year-old Hindu boy, who allegedly urinated at a local seminary, received bail, a media report said on Thursday.
According to the Dawn news report, the incident took place on Wednesday in Bhong town, about 60 km from Rahim Yar Khan city.
Besides the vandalization, the mob also blocked the Sukkur-Multan Motorway (M-5), the report added.
Citing sources, Dawn news said that a case was registered against the minor on July 24 based on a complaint filed by a cleric, Hafiz Muhammad Ibrahim, of the Darul Uloom Arabia Taleemul Quran.
The sources said that "some Hindu elders did tender an apology to the seminary administration saying the accused was a minor and mentally challenged".
But, when a lower court granted him bail a few days ago, some people incited the public in the town on Wednesday and got all shops there closed in protest, the report quoted the sources as further saying.
A video clip showing people wielding clubs and rods storming the temple and smashing its glass doors, windows, lights, and damaging the ceiling fans went viral on social media.
In response, one Twitter user said: "Ganesh Temple, village Bhong in Rahim Yar Khan, Punjab has been ravaged. Another day, another attack on Hindus in Pakistan."
Another said: "Yesterday, the mob ran amok at Temple over minor boy issue who allegedly urinated, the boy said to be mentally handicapped. Hindu community made an apology for the boy — a case registered against the nine-year-old boy. Those vandalized temples, no FIR registered against them."
District police spokesman Ahmed Nawaz Cheema said Rangers had been deployed in the troubled area and the situation was under control.
A small town close to the River Indus and Sindh-Punjab border, Bhong houses a number of gold traders who originally hail from Ghotki and Dehrki (Sindh), according to the Dawn news report.
A ruling PTI member representing the minority said he had been in touch with the local Hindu community and influential Rais family of Bhong since the issue surfaced.