Addressing stimulants on several fronts

We are beginning to see more evidence that policy, research and treatment leaders want to get out in front of rising illicit stimulant use, in anticipation of a simmering drug crisis. Leaders can and should give attention to more than one drug trend nationally, suggest experts quoted in our recent article by Alison Knopf. Also, our recent report from Norman Hoffmann, PhD, and colleagues documented a growing problem with stimulant use among locally jailed offenders.

So it didn't come as much of a surprise that cocaine addiction treatment even found its way into last month's discussion in the U.S. Congress on opioid-focused legislation. A bill approved by the House on June 20 to allow for broader Medicaid payment for inpatient addiction treatment services included treatment for opioids and cocaine, even though the bill was considered part of a legislative package designed as a broad-based opioid crisis response.

Investigation into stimulants is taking on urgency in the research community as well. The longstanding search for targets for potential cocaine addiction treatments recently took on a new dimension at a Mount Sinai research lab in New York. Researchers led by Eric Nestler, MD, PhD, director of the Friedman Brain Institute at the Icahn School of Medicine at Mount Sinai, examined changes in gene expression associated with cocaine use, but did not limit their analysis to genes already known to be associated with addiction.

Their results, published in Biological Psychiatry, offer hope for eventually identifying targeted treatments that could have an effect on all reward-related regions in the brain. “You could possibly hit one target and affect all of the reward circuitry,” Deena Walker, a postdoctoral fellow in Nestler's lab, tells Addiction Professional.

Walker explains that the study using mice evaluated changes in gene expression throughout the life cycle of addiction, not at just one stage of exposure. The researchers also looked at a much larger universe of genes than what is typical in these studies.

This led to some noteworthy findings. While some molecular research has tended to identify gene alterations that differ across the brain (perhaps increasing in some areas but decreasing in others), Nestler's team was able to identify molecules that changed in the same direction across different regions. These molecules could be attractive targets for future medication treatments for cocaine dependence, for which there is still no approved medication. “Our lab is now focusing on manipulating these molecules,” Walker says.

We will share more perspectives from the research, enforcement and treatment communities this November when we present our first National Cocaine, Meth & Stimulant Summit, Nov. 12-14 in Fort Lauderdale, Fla. A wide of range of topics at this timely meeting will include leveraging data to monitor stimulant use trends, examining patterns in stimulant use epidemics, and exploring psychostimulant use disorders in young adults.