Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
Pain points - Overcoming the Opioid CrisisCompleteRx
Today, 11 percent of Americans experience daily chronic pain, for which opioids are frequently prescribed. Unfortunately, what started as standard prescribing practice has become detrimental, and due to their highly addictive nature, we’ve seen a quadrupling number of opioid overdose deaths from 1999 to 2015, killing more than 90 people per day. While state and national legislatures continue to search for ways to combat this epidemic, significant change can be made at the community level starting with medical staff, hospitals and health systems. This webinar will provide a comprehensive overview of the pain crisis and how it affects various patient populations, outline CDC guidelines on opioid use for chronic pain and identify strategies to positively impact the use of opioids and outcomes.
Sources: NCCIH, NPR
Key Takeaways:
- Recognize the relationship between opioid use on clinical and economic outcomes in various patient populations and the community
- Outline recommendations suggested by CDC guidelines on opioid use in chronic pain and new pain standards just released by TJC
- Identify strategies to impact multiple drivers of the opioid crisis
Pain management is a critical component to patient care. However, it is leading to opioid addiction at an alarming rate in the United States. For many patients, a paradigm shift is needed to go from pain management to pain recovery.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Dr. Francis Collins keynote
1. Opioid Drug Abuse: NIH Research
Francis S. Collins, M.D., Ph.D.
Director, National Institutes of Health
5th Annual National Rx Drug Abuse and Heroin Summit
March 29, 2016
2. NIH: Steward of Medical and Behavioral
Research for the Nation
“Science in pursuit of fundamental
knowledge about the nature and
behavior of living systems
and the application of that knowledge
to extend healthy life and reduce
illness and disability.”
...
4. NIH Research: Opioid Drug Abuse
Pursuing fundamental knowledge of pain
Developing alternatives for pain management
Limiting abuse of opioids
– Enhancing safety
– Predicting addiction
– Improving treatments for addiction and overdose
5. Knowledge of Pain Pathways –
New Biomarkers for Pain?
New study to determine role of glial cells in pain
Pairs patients with low back pain (LBP) and
healthy controls
– Uses imaging to detect levels of specific glial protein
– Paradoxically, higher levels = less subjective pain
Demonstrates role of glial activation in human pain
– Possible biomarker
– May suggest new treatments for chronic pain
Loggia et al., Brain 2015;138.
6. NIH Research: NIH Pain Consortium
NIH-wide effort to enhance pain research, including:
Centers of Excellence in Pain Education (CoEPEs)
Task Force on Research Standards for Chronic Low Back Pain
Pathways to Prevention: Efficacy of Opioids for Chronic Pain
NIH Blueprint for Neuroscience Research’s Grand Challenge on the
Transition from Acute to Chronic Neuropathic Pain RFA
7. 2011: Institute of Medicine calls for coordinated approach
to relieving burden of pain in U.S.
– Tasked Health & Human Services to develop plan
2012: HHS created the Interagency Pain Research
Coordinating Committee (IPRCC)
IPRCC: chaired by NIH, brought together nearly 80
experts from public and private sectors
– Received public comment on draft Strategy
March 2016: National Pain Strategy released
NIH Research: A National Strategy for
Reducing Pain
Department of Health and Human Services
8. Public
Education &
Communication
Disparities
Care &
Prevention
y
nt
Focuses on Six Key Areas
Major Objectives:
Develop methods to improve pain prevention, management
Devise system of patient-centered integrated pain management
practices
Reduce barriers to, improve quality of, pain care - particularly for
vulnerable or underserved populations
Increase awareness of pain, care options - for public, patients,
health care workforce
9. NIH Research: Opioid Drug Abuse
Pursuing fundamental knowledge of pain
Developing alternatives for pain management
Limiting abuse of opioids
– Enhancing safety
– Predicting addiction
– Improving treatments for addiction and overdose
11. Study of Rare Disease Points to
New Target for Pain Control
Congenital analgesia: rare condition, individuals cannot feel pain
– Mutation identified in gene that encodes for Nav1.7 – sodium channel
that regulates pain-sensing neurons
Targeting Nav1.7 to produce analgesia
– Several companies now have drugs in pipeline to block channel
Targeting complications
– Understanding what happens when Nav1.7 is blocked
– NIH grantees developing new, more selective drugs to block Nav1.7
12. NIH Research: Opioid Drug Abuse
Pursuing fundamental knowledge of pain
Developing alternatives for pain management
Limiting abuse of opioids
– Enhancing safety
– Predicting addiction
– Improving treatments for addiction and overdose
13. Limiting Abuse by Enhancing Safety
Opioid deterrent formulations
Pro-drugs
Tamper resistance
Drug combinations with adverse effects if injected
14. Enhancing Safety: Prodrugs
Problem: changing method of taking opioids – i.e., crushing, injecting –
increases euphoria and abuse
Challenge: develop drugs that resist tampering
Research response: oxycodone prodrug BIO-MD™
– Inactive compounds metabolized in the body to produce active drug
– Has broad potential across all known prescription opioid drugs
• Achieved human proof of concept with PF329, hydromorphone prodrug
• PF614 is lead abuse-resistant opioid drug program
15. Limiting Abuse by Predicting Addiction
OPRM1 encodes for the target of
opioids – and varies from person to
person
– Can variants predict likelihood of
addiction?
OPRM1 variant
– Affects specific receptor levels in brain
– Associated with increased risk for
addiction, overdose severity
Hancock et al., Biol Psychiatry 2015; 78.
Manini et al., J Med Toxicol 2013; 9.
Peciña et al., Neuropsychopharmacology 2015; 40.
Variant Common Type
Mapping the differences
16. Rosenthal et al., Addiction 2013;105.
Improving Treatments for Addiction:
Extended Release Medications Improve Compliance
Buprenorphine: partial opioid agonist
– Has lower abuse potential
– Suppresses symptoms of
withdrawal
– Helps people stay in treatment
Implanted buprenorphine may
improve compliance
– Trial: buprenorphine implants
vs. placebo for 6 months
EVA polymer Probuphine®Buprenorphine
+ =
17. 5.4 5.4 5.6
0.9
2.3 2.4
0
1
2
3
4
5
6
Buprenorphine Referral Brief Intervention
Baseline 30 days
Improving Treatments for Addiction:
Implementing Medication-Assisted Treatment
Emergency department-initiated buprenorphine
– Reduced self-reported, illicit opioid use
– Increased engagement in addiction treatment; decreased use of
inpatient addiction treatment services
Days
Self-Reported Illicit Opioid Use in the Past 7 Days
18. Improving Treatments for
Pregnant Women Addicted to Opioids
Methadone: recommended treatment for addiction in pregnant
women; however, prenatal exposure associated with neonatal
abstinence syndrome (NAS)
– Often requires extended hospitalization
– Incidence almost doubled in 4 years
Buprenorphine: alternative treatment?
Trial: offspring of mothers receiving buprenorphine compared to
methadone had:
– Shorter hospital stays (10 vs 17.5 days)
– Shorter duration of NAS (4.1 vs 9.9 days)
19. Using Research to Improve
Opioid Intervention Services
NIH is partnering with the Appalachian Regional Commission to fund
grants to address increased opioid injection drug use in the region
One-year research planning grants to:
– Improve understanding problem’s scope; contributing health trends
– Identify resources, obstacles
Goal: build foundation for better intervention programs, larger-scale
research efforts to address this public health threat
Applications now being accepted
– RFA-DA-16-015: Due April 28
http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-16-015.html
20. Improving Treatments for Addiction:
Naltrexone
Naltrexone: opioid antagonist related to naloxone
Extended release formula (Vivitrol) approved by FDA in 2006 for
alcohol dependence; approved for opioid addiction in 2010
– First non-narcotic, non-addictive extended release medicine for
treatment of opioid dependence
Multiple NIH-supported
clinical trials now underway…
21. Overdoses in 78 weeks:
Control: 7
Naltrexone: 0
Improving Treatments for Addiction:
Naltrexone Trial Shows Promise
Participants: parolees/probationers with opioid addiction – all
volunteers – received either
– Monthly injections of extended release naltrexone for 6 months
– Community treatment, including methadone or Suboxone (encouraged)
O’Brien et al., Poster presentation at the Annual Meeting of the College on Problems of Drug Dependence, June 2015.
Relapse Frequency
ProbabilityofNoRelapse
Weeks
Treatment as usual
Naltrexone
22. Naloxone: medication that can halt an opioid overdose
– Original formulation delivered by injection
Lay-friendly administration: intranasal naloxone
– NIH and FDA supported development
– Overdose education and naloxone distribution (OEND)
programs demonstrated to be effective
NARCAN Nasal spray device
– $37.50 per 4mg
Approved by FDA, November 2015
Improving Treatments for Overdose:
Naloxone
Image courtesy of
ADAPT Pharma, Inc.
23. Coming soon: the Precision Medicine Initiative®
An opportunity to advance research on common U.S.
medical problems – including opioids
www.nih.gov/precisionmedicine
24. “We lose almost a hundred Americans a
day from overdoses of prescription
medicine and heroin…. We need a
holistic, multipronged approach to the
epidemic.”
~Rep. Hal Rogers
Appropriations Hearing
March 16, 2016