Evidence on Buprenorphine Dose Limits: A Review 🔓
Journal of Addiction Medicine
This study discusses the evidence regarding buprenorphine dosing, noting the Food and Drug Administration’s (FDA) product label target dose of 16 mg/d. Early dose recommendations were based on mu receptor occupancy, and FDA buprenorphine literature states occupancy implies little difference between 16 and 24 mg. However, clinical studies demonstrate effectiveness at higher doses, including effects such as blocking the rewarding effects of opiate agonists, complete suppression of apnea from fentanyl, and improved treatment retention. These effects all require doses greater than 16 mg/day and upwards of 32 mg/day, thus urging the FDA to reconsider buprenorphine dosing guidance.
Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022
While buprenorphine (BUP) is recommended for treatment of adolescents with opioid use disorder (OUD), it is unclear how often it is available to adolescents in residential treatment facilities. The authors conducted a "secret shopper" approach to survey 160 residential treatment facilities and found 39 (24.4%) offered BUP either at the program or through outside clinicians. Among those facilities, 17 initiate and provide ongoing BUP, 12 initiate BUP but discontinue before discharge, and 3 continue BUP if the patient is already prescribed. Of the facilities, 27 (22.3%) required adolescents to not be receiving BUP. Given these findings, adolescents with OUD face significant barriers in accessing BUP, the recommended standard of care, in residential treatment settings.
Use of a Fitbit-like device in rats: Sex differences, relation to EEG sleep, and use to measure the long-term effects of adolescent ethanol exposure 🔓
Alcohol Clinical and Experimental Research
There is evidence that alcohol use in adolescents is associated with disturbances in circadian rhythms, but it can be difficult to untangle the effects of alcohol and other lifestyle factors. To better assess the impact of alcohol, animal models can be utilized. In this study, researchers utilize a "Fitbit-like" device ("FitBite") to track adolescent rat activity patterns during 4 weeks of alcohol exposure, "acute" withdrawal (24 hours), and protracted withdrawal (4 week). There was a decrease in overall activity during the intoxication phase and more episodes of activity of shorter duration in light (day) during "acute" and protracted withdrawal. These findings support evidence of sleep disturbance that can persist after alcohol withdrawal.
Anticipation of Appetitive Operant Action Induces Sustained Dopamine Release in the Nucleus Accumbens 🔓
The Journal of Neuroscience
This study investigated the details of dopamine release in the nucleus accumbens in response to a cue followed by a food reward. To measure dopamine release, electrodes were placed in the nucleus accumbens of male rats, who were then divided into 2 groups: Pavlovian conditioning and operant conditioning. In both groups, dopamine increased when the light appeared but only in the operant conditioning group was the dopamine level sustained during the cue. The authors conclude that sustained dopamine release served to motivate the rat to execute the lever press. This evidence ties the mesolimbic dopamine system to motivation in addition to reinforcement learning.