Ocean Holds Opioid Alternatives

In the United States, we are in desperate need of opioid alternatives when it comes to the treatment of pain. It is fair to say that the problems we face with opioid addiction today, would not be so severe if opioid painkillers were not so effective. Calls to look for alternative forms of pain management have been loud in recent years, yet physicians may be scratching their heads about what to prescribe instead. Unfortunately, many pain sufferers do not respond to meditation and acupuncture. And frankly, severe pain can require the use of powerful opioids.

Those tasked with developing opioid alternatives for pain relief are researchers at any one of a number of colleges/universities around the country. But effective research requires large teams working thousands of hours. The point being, finding opioid alternatives could take years to accomplish—when we need solutions now. Nevertheless, researchers trudge sedulously to find such alternatives, sometimes looking for answers in the strangest of places.

A number of medications currently used today have their origins in the tropical rain forests of the world. But when it comes to pain management, new options may be residing in the deep blue sea. Meet Conus regius, a species of sea snail that is both predatory and venomous.

Conus regius (Credit: Zsnapper)

Researchers at the University of Utah have isolated a compound from the snail's venom that acts on a pain pathway different from the pathway targeted by opioid painkillers, GEN reports. The compound, RgIA4, was successful at blocking alpha9alpha10 nicotinic acetylcholine receptors (nAChR) pain pathway receptors in rodent models. The research was published online in the Proceedings of the National Academy of Science.

"RgIA4 works by an entirely new pathway, which opens the door for new opportunities to treat pain," said J. Michael McIntosh, M.D., professor of psychiatry at the University of Utah Health Sciences. "We feel that drugs that work by this pathway may reduce the burden of opioid use." 

The Conus regius sea snail could be vital for the development of new painkillers that do not carry the same risks as opioids. What’s more, while RgIA4 works its way through the body in only 4 hours, the pain-relieving effects of the compound were still working 72 hours after the injection, according to the article. Dr. McIntosh points out that the majority of painkillers used today are not sufficient in addressing chronic pain. Better alternatives may be found in the ocean. Really exciting stuff.

“Nature has evolved molecules that are extremely sophisticated and can have unexpected applications," says Baldomera Olivera, Ph.D., professor in biology at the University of Utah. "We were interested in using venoms to understand different pathways in the nervous system."

Depression and E-Cigarette Initiation

Last week we covered an alarming new trend regarding e-cigarette use among young people, known as “dripping.” We felt it important to keep the conversation about e-cigs going, considering the device's growing popularity among young people.

Smoking cigarettes has long been associated with a form of stress release, much like having a beer at the end of long day. Who hasn’t known someone who, when stressed out, said aloud, “I need a cigarette.” People don't just smoke when they are stressed. They smoke to alleviate anxiety and depression, as well. Some even smoke to quell their appetite, at times. Such behaviors are often what addiction is built upon, associating a specific action with relief.

In the field of addiction medicine, it is quite common for patients who report their addiction being the result of self-medicating untreated mental illness, such as depression or bipolar disorder. Such instances are referred to as co-occurring disorders. When mental illness is left untreated, people will often look to potentially dangerous remedies, like drugs and alcohol. But let’s get back to nicotine for the time being.

In recent years, there has been a heated conversation about electronic cigarettes, specifically with regard to the benefits over traditional tobacco products and the potential health risks. It is fair to say that at the end of the day researchers (in most cases) do not yet have definitive answers regarding the pros and cons of e-cigarette use. While most will agree that e-cigs are likely a safer alternative to other methods of nicotine delivery, yet there is widespread concern in the health community about the impact of the vapor devices on young people.

Concerns have also been put forth of late regarding mental health and e-cigarette use. A study conducted by researchers at The University of Texas Health Science Center at Houston (UTHealth) showed a link between depression and initiation of e-cigarette use among college students, according to a UT press release. The findings were published in Nicotine & Tobacco Research.

While the researchers could not find evidence that e-cigarette use leads to elevated symptoms of depression, the study showed that college students who had had elevated levels of depressive symptoms were at a much greater risk of starting to use e-cigs, the article reports. The relationship was surprising to the researchers because the same could not be said for the relationship between depressive symptoms and traditional cigarette initiation.

"We don't know why depression leads to e-cigarette use. It may be self-medication. Just like with cigarettes, when students feel stressed out, using e-cigarettes may make them feel better. Or it could be that since e-cigarettes have been marketed as a smoking cessation device, depressed students may be using e-cigarettes to help them quit smoking traditional cigarettes," said lead author Frank Bandiera, Ph.D., assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health in Dallas. 

The study was the first of its kind to establish a longitudinal relationship between the depression and e-cigarettes, according to the article. Further research will be needed to determine what the relationship means.

Teenage E-Cigarette Dripping

The e-cigarette conversation continues as more and more teenagers are using the devices. A 2015 survey found that 24 percent of high school students reported using e-cigarettes during the past 30 days, per the Centers for Disease Control and Prevention (CDC). While the Food and Drug Administration (FDA) has finally been given authority to regulate e-cigs, creating age restrictions, the devices are still being used by minors and young adults.

Most experts agree that electronic cigarettes are less harmful than other forms of nicotine delivery. However, nicotine is still addictive and can potentially start young people on the road to harmful behaviors that can lead to addiction. Furthermore, e-cig nicotine juices come in a number of flavors that can keep people coming back for more, where as traditional cigarettes have one flavor—you either like it or you don’t.

There have also been concerns raised about nicotine levels in e-cigarette “juices,” and how the devices are used. A new trend called “dripping,” allows e-cigarette users to get more bang for their buck, HealthDay reports. In fact, a survey shows that 1 in 4 teens have reported having tried dripping. So, what is dripping?

Normally, e-cigs users inhale to gradually draw the e-juice into a heating coil through what are known as “wicks,” creating a vapor, according to lead researcher Suchitra Krishnan-Sarin, a professor of psychiatry at Yale University School of Medicine in New Haven, Conn. "Dripping" is when e-cig users place drops of the nicotine juice directly onto the exposed heating coil and then quickly inhaling the thick vapor cloud produced. Krishnan-Sarin’s survey indicates that 26 percent of student e-cigarette users at eight Connecticut high schools has "dripped."

The immediate or long term health consequences of dripping are not known yet, according to the article. Although, the chief of general pediatrics of Mount Sinai Health System in New York City, Dr. Karen Wilson, says that the more potent nicotine could impact the developing brains of teenagers.

"Adolescents should not be using nicotine at all," Wilson said. "It changes the brain chemistry, and adolescents are uniquely susceptible to the addictive properties of nicotine." 

The findings of the report were published in Pediatrics.