A new area of the brain has been correlated to addiction, especially nicotine, according to a study done at the University of Massachusetts Medical Center. The interpeduncular nucleus is an area at the base of the midbrain, just above the top of the spinal cord. Dr Andrew Tapper and his team noted increased neural activity in this area when his nicotine-addicted mice began to have withdrawal symptoms, as reported in the journal Current Biology. Scientists say treatments aimed at reducing activity in the interpeduncular nucleus could one day help people overcome addiction and especially cravings. A unique and fairly new strain of medical marijuana called Charlotte’s Web is extracted from Cannabidial, or CBD, a cannabinoid without the Delta-9 THC which gets people high. It is particularly effective in treating childhood epilepsy. And in a statement from HHS Secetary Kathleen Sebelius, the administration has made it very clear that insurance companies must cover mental health and substance abuse treatment in the same way as they cover other chronic, persistent disorders like hypertension, diabetes, asthma, etc.
Transcript (edited):
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions. I am Howard LaMere. In our perusal through the news, several different stories showed up. One of them was a recap or a repeat of something we talked about a couple of weeks ago and that’s college students using a variety of drugs for stress and for studying and this comes out of Switzerland I believe and it showed pretty much identically the same thing — about 1 in 7 college students admitted to using mostly ADHD drugs – Adderal and Ritalin – but also some others, like designer drugs. A couple marijuana stories that are interesting. Research into Charlotte’s Web which is a strain . a unique strain of marijuana – the CBD kind and we’ll go into that a little bit. And Lady Gaga, I guess recently admitted to marijuana addiction and I don’t know if she’s in treatment for that or not. And then there’s a story or two about the way heroin and opioids change the body and change society. And one more on research that’s coming out of the University of Massachusetts medical school . research into a brain area, a different brain area somewhat, that might be involved in addiction, especially looking at nicotine addiction, but it might apply to many other addictions. So, Darryl, that’s a long list of things. Any one in particular strike you as a fascinating place to start?
DARRYL: Well, they all seem fascinating. I quite frankly didn’t see the articles you’re talking about on the ADHD medications, also the one on heroin and opiates changing the body through their use and addiction. So, the studies that I did have the same curiosity to was first this new area of the brain that researchers at Massachusetts led by Dr. Andrew Taper in studying mice, he had identified that when mice go into nicotine withdrawal, researchers are able to identify their withdrawal by specific behaviors that the mice are doing, and then looking at the brain and what’s happening with the brain, they identified a new area that I didn’t know about before called the interpeduncular nucleus and that’s an area . it’s a very, very small area actually, right at the base of where the brain and the brain stem meet, but still it’s a part of the middle brain or mesocortex, the mammalian brain, and they’ve found that it’s hyperactivity in that area of the brain corresponded to the mice suffering many of the physical symptoms of withdrawal and it’s something, I believe, that is related or partially related to further down in the brain stem but very close by actually.but actually in the brain stem itself, the area called the nucleus accumbens right near the mid-brain, but actually in the spinal cord itself.an area called the locus coeruleus and that nuclei and that locus coeruleus we know has been identified as being hyperactive and a huge catecholamine or adrenaline, noradrenalin, and dopamine area in the brain that gets hyperactive during alcohol withdrawal, depressing withdrawal, and opiate withdrawal. The anti-high blood pressure medicine Clonidine has been effectively targeted and has been used for many decades now as a non-approved medication for treating withdrawal symptoms, but this other area of the brain is sort of near there and it’s also hyperactive . it may explain why, we’ve only been partially effective in treating withdrawal symptoms with this anti-hypertensive medicine that targets the locus coeruleus and we’re going to have to find new medication that targets this new area of the brain that becomes hyperactive and seems to be responsible for a lot of withdrawal – they say not only of nicotine, but of other drugs like alcohol and opiates as well. So it looks like the withdrawal process is much more involved, and we always thought it was. We simply thought previously that it was emanating from a specific part of the brain, maybe it is several parts of the brain and its brain stem that it is emanating from, but again, it’s going to give us new resources to develop . to manage those areas of the brain so that addicts and nicotine addicts who go into withdrawal aren’t going to be debilitated by those symptoms and seek out continued use of nicotine or other drugs in order to manage their withdrawal state – so I’m very excited about that and it’s of deep interest to me.
HOWARD: Do you think that different areas are related in the context of, do you think they communicate with each other or do they act, in your opinion, completely independently?
DARRYL: I really think the whole brain has the ability and need to communicate with itself. I mean, that’s why it is there. It’s the main coordinating, communicating organ of our body. As we begin to specify these areas and tease them out, we’re going to understand why we’ve got multiple areas or at least in this case two, that are involved with the brain process of withdrawal symptoms, and why they are there, and why they are communicating with each other and maybe even ways that disrupt that communication that may have withdrawal. But right now we’re just targeting medications, or other processes, merely to shut those areas of the brain down, so that we mitigate withdrawal symptoms.
HOWARD: Now another kind of related research story.this one coming out of Salt Lake City where there has been ongoing research into a kind of cannabinoid called, “Cannabidiol”.is that correct? CBD?
DARRYL: Yes.it’s an actual phyto chemical, which is an actual chemical in marijuana itself. It’s one of the 60 or so brain active chemicals that are in marijuana so it’s already in the plant but usually there’s a low concentration of that in the plant versus THC and delta-9-THC as everybody knows is the main psychoactive drug in the plant or main psychoactive substance that gets you high. CBD we have known for a long time, doesn’t have that ability to really get you that “affected” in the brain. It doesn’t affect the brain in terms of getting you high, but if affects CB1 receptors, meaning out of the brain, stronger, and even the brain receptors that are involved with a lot of the what we’re looking – a lot of medical effects that marijuana has . so especially seizure activity, which is a brain activity, CBD is much more powerful than THC in controlling that activity in the brain and it has been very useful in children. Dr Sanjay Gupta, I think we talked about his special, highlighted it and actually Charlotte’s Web was created in that show for the little girl. I forget how old she was. I think she was preschooler who was suffering from intractable seizures and they had tried every medication, they tried every process they could to control them . they showed pictures of her just continually seizing and she was very near death and they finally discovered in contacting this Colorado group . and this Colorado group had developed this new strain, this new hybrid of marijuana that contained a much greater ratio or much greater proportion of CBD, Cannabidiol, as compared to THC. I think the THC concentration of their plant was only about .3 or .03 percent THC and as you know, we’ve been talking about the percentage of THC in marijuana has continued to increase as more and more people get tolerant to it and more and more people get abuse it and demand a more psychoactive effect. You know, we’re looking at an average, maybe 14, 15 percent THC in the average street marijuana that’s being confiscated and looked at right now. Well, they hybrid the marijuana so that it has only about .3 or even less than that, .03 somewhere in that range of THC and yet a higher proportion of CBD, Cannabidiol, and therefore it has all the medical benefits that we seek out of marijuana without creating the addictive or the psychoactive effects that we don’t want out of marijuana. And the sad thing in that special.continues to be.is the company who created it, first of all, aren’t making any money. They’re going broke because nobody will buy their stuff because most the people buying medical marijuana aren’t buying it for its medical properties, they’re buying it to get high off of it. The other ..
HOWARD: Ahhh . the truth comes out!
DARRYL: And so the other problem that these people who had hybrid Charlotte’s Web were facing is that Charlotte, who they named their hybrid marijuana after, with the high CBD and low THC, actually lived in the state of Utah and that’s where her family was and they were making this product and growing it in Colorado and so the family had to travel to Colorado in order for her to gain treatments, which is extremely prohibitive and costly and they were going broke and so the people who made Charlotte’s Web are now appealing to the Utah legislature to say, we’re making this product..it is true medical marijuana and we would like to transport it across state lines into your state. There’s probably some federal jurisdictions that they’re going to have to worry about as well because that’s transporting something.a controlled substance over state lines, but they make the first sound and first truly viable argument for medical marijuana. They have a product that they are showing to be extremely effective in treating a lot of different medical conditions. It has very low abuse or get high potential and I think.I support them. I think they should be allowed to bring that over and I think they should have more patients on it and they should get more support so that they can keep doing their research, keep growing their substances and really having a viable medical marijuana instead of what everybody else seems to be doing with the laws is just using it as a smoke screen to get high and get loaded on it, so.that’s a deep concern to me and I think every person who needs to use medical marijuana should be really supportive of this group and what they’re doing and I would be kind of pissed or be very upset at the people who continue to misuse medical marijuana merely as a means of getting high.
HOWARD: Well, it’s an ongoing evolving story.this medical marijuana.
DARRYL: I did want to add to that from something you did mention also at the top of the show here, Howard..and that was the Lady Gaga admitting that she is addicted to marijuana and then, people from Time Magazine and people from.maybe even People Magazine and the show that she announces on was a Z100 morning show that supposedly is supported by People’s Magazine, but people saying.what is she talking about? How can marijuana be addictive? Marijuana is not addictive and even some comments by Time executives saying that, marijuana does have the physical withdrawal.we know that.it’s codified and in the DSM5, but its withdrawal symptoms are really very benign, not too severe, and it’s not like the terrible heroin withdrawal or alcohol withdrawal, so in our view they say it’s really not addictive. Well, it’s such a silly thing because, you know, it is certainly well recognized and we have now diagnostic criteria for properly diagnosing whether or not somebody is addicted to marijuana and somebody goes through withdrawal from marijuana. We have about 300,000 people treated with their drug of choice being marijuana every year in this country and for the general public and for the conventional wisdom to come out and continue to say this is not an addictive drug and it has. it’s natural and organic and has no problem.it just befuddles my mind. I just can’t understand why they want to do that. And on the heels of that, I was interested in a paper that was published in the new NIDA announcement – the National Institute of Drug Abuse – as their news updates and the one thing they had in it that really caught my eye was that they are now developing, like treating all addictions, there’s this huge development of medications to treat addiction. Like I said, it used to be an oxymoron, but because now we know the actual biology and the pathways of addiction and what’s happening in the brain, we’ve recognized that we’ve been effective in treating the cortex.the thinking area of the brain – the conscious area of the brain in addiction. But we’ve totally neglected the unconscious areas of addiction – the unconscious brain, the mesocortex. And so there’s been a huge development of different medications to treat addiction, of which a person.it’s not a person’s consciousness and something they control, it’s a totally unconscious basis and in their latest announcement, the National Institute of Drug Abuse announced that they are working on kynurenic acid. It’s a natural substance that occurs in the brain that they’re finding has the ability to reduce the function of a certain acetylcholine receptor site, but in a huge way decrease the ability for marijuana to create its emotional and addictive properties. So we’re developing medications to treat it. It’s in the standard diagnostic manual and yet we still have the mainstream media saying, marijuana is not addictive and I find that, you know, unconscionable.
HOWARD: Well, like I said.it’s an ongoing story and we will hear more of it I’m sure. But we were speaking about laws there and in the context of marijuana and state lines.another interesting piece of law related news that I neglected to mention at the beginning was that the Secretary of Health and Human Services, Kathleen Sebelius, announced recently that the Affordable Care Act – Obama Care is going to make sure that it includes the coverage of mental health and substance abuse treatment at the same level as regular physical maladies. So, we’ve been talking about this for quite awhile, but the Secretary of Health & Human Services, Sebelius, came out and made the very clear and straight forward statement to that effect, so I thought that was very interesting.
DARRYL: That is interesting because that was always assumed that that was going to happen. I mean the purpose of making laws is making people accountable to do things that they aren’t doing and currently the big thing, unfortunately it’s one of your major mantras — follow the money — and I think part of the main reason why that 2008 law got passed and signed by President George W. Bush, the Addiction Equity Act and the Mental Health Parody Act was because insurance companies were not covering addiction treatment like they were covering other medical problems that people were buying their insurances for..leaving the federal government with the bill to treat all the people who were being addicted. And I think the last time I looked it was about 80 to 90% of the people receiving treatment for addiction.the addiction was being paid for by the federal and state and county governments and insurance companies that were charging people for premiums to include even addiction treatment, were only covering about 10% or 15% of those claims and paying for that. And so, I think if it was a follow the money thing, the government says, we’re not going to put up with this anymore and these insurance companies.they’re going to have to walk the line.they’re going to have to pay for it and I think that’s really why the act got passed. But I was disappointed in this rhetoric and the things that are coming out of Washington and everything because it’s also missing, I think, the most important part of this law. I mean, how can they do this or how can the government make the insurance companies pay for a condition that is viewed as a matter of choice or weak-willed or morals or anything like that and so the bill was passed and it was a clear statement, I think, that the federal government was making based upon the information they had that addiction is a true biological medical disorder. It’s a true illness. It’s a true disease and if you’re going to, you know, if you’re going to treat diseases, it deserves to be treated in the same vane and at an equal basis that we’re going to treat other chronic persistent disorders like diabetes and epilepsy and everything like that. And that even a larger implication, Howard, to me..that meant that this would be covered by the ADA Act . Americans with Disability Act. The other thing was that this would be covered by the Americans with Disability Act and then for insurance companies, for sure, but maybe even other people..even in the work force.even in applying for different things, that you couldn’t discriminate against people who had addiction. You could discriminate if they’re not taking care of their addiction, they’re not managing it and they’re making mistakes or doing terrible things. That’s not discrimination. You’re fining people for not being able to perform their job or not being able to perform their task or whatever you have them working under. But if everything is going good and they’re working fine and especially if they’re in a recovery system, you can’t discriminate against somebody just because they’ve been treated for addiction or they have addiction or whatever. You have to do the right thing first and that was to get them into treatment or make sure they are compliant with treatment. And that is what I think is the whole future legacy of that act and I really hate to see it just relegated to just the insurance part and the Affordable Care Act and everything we are doing now. That’s an important part of it. But the other important part of it is we need to be ending this discrimination against addicts and alcoholics just because they have a chronic, persistent medical disorder.
HOWARD: Well, I think it’s important that you make that point there that it was not really viable to do anything or try to.especially to mandate anything while it was still considered an option whether you took drugs or drank a lot of alcohol. And so the change in the viewpoint of that and the scientific medical point of view of that was crucial to the evolution. So, that’s probably about all the time we have for now. I think we’ve covered most everything, haven’t we?
DARRYL: Well, there are 2 other things. I didn’t see any of the articles and they might have been previous articles.one was the ADHD medications being abused in colleges and used more and more by people without the condition or people who make up the symptoms so they can get a prescription for these drugs.like Adderal which are methamphetamine amphetamines or Concerta which is Ritalin or Ritalin itself or Cylert, methylphenidate and all these other things that are used that are actually just stimulants. They’re actually seen as stimulants.they’re all like methamphetamine. And the reason that they’re using it in college and we see abuse of it is because it does produce a focus on the mind and when you’re cramming for your test, if you hadn’t done your homework.you hadn’t studied all week and you’re cramming, it helps you do many things. It focuses your attention on the task of learning what you got to learn.it takes away the drowsiness and sleepiness so you stay up all night and you don’t have to.maybe even eat or need to eat or partially hydrate yourself because it’s causing that effect that stimulants do, causing anorexia, making you not hungry at all. And so, I can clearly see that people use this to get better grades and help them study and focus, but it has long been noted that when you study under the effects of a stimulant drug, your short-term memory is enhanced, but your long-term memory is impaired.
HOWARD: So you forget it all in a couple weeks.
DARRYL: Yeah, in just a week you don’t remember what you did. I’m not sure I want to be treated by a doctor who got his MD degree purely by being a methamphetamine user because you know he did great and probably was the top of his class, but then when it came down 10 years later to treat my appendicitis, you know, who knows what’s going to happen! So that’s a concern that is happening. The other story you mentioned that I didn’t see an article on was the heroin and the opiates and was a change in.what was that now?
HOWARD: Yes.that’s on Med Page here and it’s a doctor at Mount Sinai Hospital in New York, Yasmin Heard at the ICAN school of Medicine at Mount Sinai, so that research is coming out of doing postmortem exams of people that have had long-term heroin use, opioid abuse and finding that it significantly changes the DNA and the way that the brain functions and the overall plasticity of it. But I will print that out for you, Darryl.
DARRYL: There’s no doubt about that. We already have all of the brain imaging studies and everything showing massive, massive impact of chronic opiate abuse. We know about the hyperalgesia and allodynia in terms of pain. We know it turns off your natural productions of endorphin and encephalon, and then on top of that if you’re using illicit drugs, especially a drug that’s injected like heroin, then you’re going to expose yourself to a massive number of adulterants and misrepresentations and all that. Ever since I’ve been in this field, over 50 years ago now.and treating addicts, opiate addicts seem to have much more medical, massive damage than other addicts because they were injecting things. And just on the heels of that, it gave me a chance.that’s why I wanted to mention it.there’s many articles coming out from the United Nations and other people.New York Times, I think it was and national public radio that Afghanistan, again, they’re recording a record opium crop and a record production of heroin after some.from all the international efforts and monies from this country, I think it was mentioned someplace they spent 7 billion dollars to have farmers grow other crops to control its production, to shut down these factories, and they were reporting that there’s less acreage and less planting, well how do we end up again with a massive increase in the production of opium and heroin and the statement is again that oh well, they had less acreage but they had more productivity in those acreage and those plants that they planted, they learned how to grow them better and they’re getting better at it so they’re producing more crop. On the sort of back of that though was another study that came out of.that was on the national public radio, that despite all these efforts and all the money and paying farmers not to grow opium but to grow other crops, it’s clear that the farmers in Afghanistan might gladly accept the money they were given to not grow crops, but said what the heck..we can have a double hitter here. We can be doubling our income. We take this free money and we’re going to grow opium anyway and sell it to the underground anyway, so people are growing it anyway and to them it’s not a manner of really, you know, greed and making a lot of money.it’s survival.it’s just basically very low economics there, very low abilities to make money and this is the way they make their money and this is the way they can get some sort of foot hole in life to feed their families and everything like that. So, we’re having the situation that we’re not dealing with effectively and somebody better come up with a different solution then we are doing to try and control the opium production and the heroin production in the world because it continues to grow and with the laws of basis economics, supply and demand, what’s happening here is the quality of the product is going down and the price is going down and that’s going to increase the demand for it and people are going to get more addicted to it. It really is a concern that we continue to make this mistake year after year.
HOWARD: Well again it’s follow the money. Follow the money is yeah.that seems to be the way. Anyway, that’s all the time we have for this time. As ever, thanks for listening and comments, questions, suggestions always welcome. Stop by the website, cnsproductions.com and drop us a note there. Thanks, Darryl.
DARRYL: Hey, thank you, Howard.
HOWARD:That wraps our pod for today. Thanks for visiting the CNS Podcast. Please check back soon for the next in the series and visit our website, www.cnsproductions.com