Potentially life-changing impact of internet forums on those in remission from opioid use disorder

 Active participation in internet forums has the potential to provide life-changing social benefits and wellbeing for people who are in remission from opioid use disorder.

Engaging with online communities, particularly those of a generalist nature unconnected to drug and addiction topics, can help people accrue invaluable ‘social capital’ that dramatically reduces the risk of them having a use episode during remission.

Paradoxically, being overly focused upon forums dedicated to therapy and support can in some circumstances have a negative effect, making it more likely that a person will report a use episode during remission.

These insights, arising from new research by the University of Exeter, could have significant public health implications, particularly for those who are less able or willing to engage in traditional in-person recovery and rehabilitation programmes. 

Published in the Journal of Medical Internet Research, the paper, Effects of Substance Use, Recovery, and Non–Drug-Related Online Community Participation on the Risk of a Use Episode During Remission From Opioid Use Disorder: Longitudinal Observational Study, highlights the ongoing benefits that online forums can provide many years into a person’s remission journey.

“Opioid addiction is one of the most pressing public health issues of the day,”

said research lead Dr Miriam Koschate-Reis, Associate Professor of Computational Social Psychology, in the Faculty of Health and Life Sciences.

“Whether it is addiction to prescription drugs such as painkillers, illicitly manufactured synthetic opioids such as fentanyl, or opiates including heroine, the human cost is profound.

“The provision of therapy and recovery support groups is an important step in addressing this issue, but there can barriers to accessing these services such as a lack of funding, stigma, and personal circumstances. This research highlights the impact that online groups, such as forums on popular platforms like Reddit can have. The results suggest that they may provide a lifeline for those who are in remission from opioid use disorder.”

The research team used the popular news and discussion site Reddit as the basis for the research and began by focusing upon one of its dedicated forums – or subreddits – called ‘OpiatesRecovery’. More than 31,000 members have used this forum since 2012, which offers peer support and recovery information, with many regularly making statements about their remission status, such as the number of days since they last used opioids. 

After an extensive process of data cleaning, a sample of 457 individuals was formalised, 48% of whom had reported opiate or opioid use during remission during their time on the forum, and 52% who had not. Through analysis of unique and anonymous user IDs, the researchers were able to track activities across the entire Reddit platform, enabling them to construct a picture of which other types of Reddit subforums they were engaging with. 

From this, they identified more than 1,200 subreddits, which they categorised into those that related to substance use, those devoted to recovery support, and those unrelated to either. They then recorded the number of posts and comments each participant had contributed during the 2012—2019 timeframe.

“Our findings showed that the greater the number of online non–drug-related groups an individual recovering from opioid use disorder became a part of, the lower the risk of a use episode over time,”

said Dr Elahe Naserianhanzaei, co-researcher in the Faculty of Humanities, Arts and Social Sciences.

“Indeed, this could be as much as a 5% reduction per subforum. And this effect persisted when membership in recovery and substance use groups was also accounted for. This is in line with the view that social groups deliver health benefits and create resilience.”

The findings also revealed several other notable trends that could warrant further research. The first was that while there was a benefit to engaging with forums devoted to recovery, there was a correlation between those who focused more narrowly upon such sites and those at risk of opioid use during remission. 

Secondly, participation in forums that focused on substance use was not associated with an increased risk of an opioid use episode, suggesting that online interactions with people who discuss substance use may not necessarily be harmful for those in remission.

Furthermore, the researchers found that there was some correlation between an increased amount of posting activity in recovery and general interest forums, and risk of a use episode during remission - something that the authors say warrants further examination.

“Our longitudinal study of online behaviour over six years gives us an insight into a much longer period of recovery than has previously been focused upon,”

added Dr Koschate-Reis.

“It provides the first indication that a person’s remission journey needs to continue beyond the phase where they build recovery support group memberships and move towards group participation that is non-drug related. And these results indicate that online communities can help people to make that transition.”

The study, Effects of Substance Use, Recovery, and Non–Drug-Related Online Community Participation on the Risk of a Use Episode During Remission From Opioid Use Disorder: Longitudinal Observational Study, was funded by the Engineering and Physical Sciences Research Council, and is available to download for free at https://www.jmir.org/2022/8/e36555

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JOURNAL

Journal of Medical Internet Research

DOI

10.2196/36555 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Effects of Substance Use, Recovery, and Non–Drug-Related Online Community Participation on the Risk of a Use Episode During Remission From Opioid Use Disorder: Longitudinal Observational Study

ARTICLE PUBLICATION DATE

22-Aug-2022

https://www.eurekalert.org/news-releases/963817

Understanding breast cancer recurrence, metastatic spread

 Despite advancements in cancer detection and treatment, breast cancer that comes back or spreads still presents a challenge to researchers and oncologists.

The American Cancer Society estimates that 44,130 Americans died of recurrent or metastatic breast cancer in 2021. Ten-year survival rates for patients fall from 93% to 27% when the cancer comes back and to 7% when the cancer returns and spreads to other parts of the body.

Researchers from the University of Cincinnati and Cincinnati Children’s Hospital Medical Center  are studying the biology of breast cancer recurrence. The team led by UC’s Susan Waltz, PhD, and Cincinnati Children’s Susanne Wells, PhD, published recent findings on biomarkers that help predict outcomes and could be targets for new treatments in the journal PLOS ONE Sept. 6.  

Research background

Waltz said the collaboration with Wells’ lab began around 15 years ago, as both research groups were studying different oncogenes, or genes that help accelerate cancer cell growth, called Ron and DEK. 

“We showed that both Ron and DEK are very important in breast cancer and that both Ron and DEK are independently associated with poor overall survival in breast cancer patients,” said Waltz, professor in the Department of Cancer Biology in UC’s College of Medicine and a University of Cincinnati Cancer Center member. “We know that Ron and DEK as genes are very important in predicting breast cancer recurrence, but there’s not great drugs yet that can target at least DEK right now.”

The current research focused on the role of metabolic plasticity, or how metabolism in the body is constantly changing, which plays a significant role in how cancer grows and recurs. 

“Our metabolism is ever-changing based on how we are designed genetically and also based on what we ingest and are exposed to,” said Wells, professor in the UC Department of Pediatrics, director of the Epithelial Carcinogenesis and Stem Cell Program at Cincinnati Children’s and a Cancer Center member. “And cancer cells love a certain metabolism that is called a cancer metabolism and promotes cancer formation and spread.”

Study findings

The research team found that the Ron and DEK genes can regulate certain metabolites, substances made or used when the body breaks down food, drugs or chemicals in the process of metabolism, to help cancer cells grow and spread. 

“So we went about and found changes in metabolites, and then took those changes and went back and figured out which enzymes were involved in regulating those metabolites,” Waltz said.

By studying the enzymes involved, the team identified a metabolic signature that can help better predict outcomes for patients. In addition to being a helpful biomarker, the metabolic signature itself could be a potential target for new therapies.

“We can use those metabolic pathways to understand how we might be able to better treat cancer patients so that they’re not more susceptible to breast cancer recurrence,” Waltz said. “It could be dietary, it could be different ways of treating patients compared to the toxic drugs that we give patients now.”

For example, if a high level of a certain enzyme is predictive of better outcomes, nutritional supplements or other treatments can help promote that enzyme’s activity. Alternatively, if high levels of a certain metabolite predict worse outcomes, treatments can reduce that metabolite by blocking the function of relevant enzymes in that pathway.

“Regulating metabolites is much easier than regulating genes,” Wells said. “Now we are really opening up a path that is much wider than just targeting Ron and DEK. Hopefully someday we can treat these worst features of cancer by targeting cancer metabolism.”

Waltz said further research will include looking at how Ron and DEK affect other molecules such as lipids, or fatty acids, that also play a role in metabolism. By further defining more specific metabolic signatures that align with breast cancer patient outcomes, even more avenues for new treatments may be found.

“In other words, which metabolite is most important in driving these poor outcomes and how do we target it,” Wells said. 

Ongoing collaboration 

Waltz and Wells said their labs’ partnership has gone beyond research and has included more collaborative discussions and training of students and lab staff.

“It’s been fun for my lab because I think research is best not done in a vacuum, and it’s really great when you have collaborators that take different perspectives on things,” Waltz said. “It helps to invigorate lab members a little bit because they know that science isn't being done in a bubble. And it means a lot, because we took an idea that we both had and we worked together and made that idea come to fruition.”

“It’s been really fun writing together, thinking together, but it’s also been fun bringing students and staff together,” Wells added. “It’s not that we’re adding up the contribution of each lab and achieving a little more, but it’s the synergistic effect of our tools and expertise.”

The researchers were also aided by the NMR-based Metabolomics Core at Cincinnati Children’s, a facility that provides state-of-the-art technology to researchers conducting metabolism-related research. 

“This metabolomics facility is really a great bridge for different groups and laboratories that do metabolomics work and meet in the middle, both with Cincinnati Children’s and UC, so that’s very important,” Wells said.

Waltz and Wells particularly noted the work of Sara Vicente-Muñoz, co-first author on the study and Cincinnati Children’s research associate in the Metabolomics Core, in making research progress.

“Sara has really pushed the project forward,” Waltz said. “Based on the collaboration, we had to figure out ways to do things that haven’t been done at UC and Cincinnati Children’s to make them be done. And Sara has done that for us.”

Study co-authors also include Brian G. Hunt and Taylor E. Lange. This research was funded by National Cancer Institute grants R01 CA239697 awarded to Waltz and Wells and F31 CA228373 awarded to Hunt and Waltz. The authors claim no relevant conflicts of interest.

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JOURNAL

PLoS ONE

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Cells

ARTICLE TITLE

NMR-based metabolomic analysis identifies RON-DEK-β-catenin dependent metabolic pathways and a gene signature that stratifies breast cancer patient survival

ARTICLE PUBLICATION DATE

6-Sep-2022

COI STATEMENT

The authors claim no relevant conflicts of interest.

https://www.eurekalert.org/news-releases/963544

Covid Zero Throttles China’s Oil Demand Ahead of Key Congress

 China’s oil markets are bracing for a rocky few weeks as the government enforces some of the strictest curbs on its citizens since the pandemic began.

As many as 65 million people across the country are now subject to restrictions on their mobility. Events from an annual financial forum in Shanghai to Asia’s biggest pet fair in Shenzhen have been postponed or canceled. Every lockdown of a home or place of work, disrupted holiday or delayed business trip means a lower requirement for fuel. In short, the longer China persists with its Covid Zero policy, the less oil it needs. 

And China is nothing if not persistent when it comes to the virus, as shown by its continued willingness to shut down mega-cities like Chengdu, and the tightening of restrictions around Beijing as the capital gears up for a pivotal legislative meeting. The government is doggedly pursuing its policy of eliminating the virus ahead of the party congress that begins on Oct. 16, where President Xi Jinping, the chief proponent of Covid Zero, is expected to secure a precedent-breaking third term in power.

The next two months are usually a busy period for travel due to two national festivals. But the recent virus flareups have dimmed the outlook for transport fuels, said Fenglei Shi, a Beijing-based director covering Chinese oil markets at S&P Global Commodity Insights. 

“We expect that gasoline, diesel, and jet fuel demand over September and October will continue to fall short of pre-Covid levels,” said Shi.

Quiet Streets

Traffic congestion in some of China's biggest cities has fallen

Source: BloombergNEF, Baidu

Note: Daily data indexed against January 2021 at 100

Traffic congestion in Chinese cities dropped at the end of August, while the number of trucks on its highways, which typically run on diesel, had fallen to 6.4 million on Sept. 4 versus 7.3 million a month before, according to the transport ministry. The number of daily flights, meanwhile, plunged 41% in the week through Aug. 28 compared with the same period in 2019 before the pandemic struck, according to China Aviation Daily.  

While other major economies are learning to live with the virus, China is doubling down on the rules that Xi has declared as the most economic and effective policy for the nation over the long haul. But for millions, including Shanghai-based business consultant Oscar Wang, that means disrupted travel, postponed trips and money unspent. 

In the middle of August, a pop-up window appeared on his phone’s health app that warned, according to data tracking, he may have come into contact with the virus. He was forced to cancel a trip to Beijing to see his relatives because, without a clean health code, he wouldn’t have been able to buy train tickets, commute on the subway, enter malls or dine out.

“I am not too sure why I was warned not to travel,” he said. “Perhaps it was because there was a case discovered in my district recently, but that was far from my compound.” Wang’s district in Shanghai is home to over 2 million people and reported a single infection outside quarantine in late July.

Global Repercussions

Add up all the inconveniences inflicted on citizens like Wang and the repercussions are global. China is the world’s largest oil importer, and its second biggest consumer after the US. Transport fuel accounts for about half of China’s total, so any dent to demand will quickly ripple through international markets already grappling with fears that the global economy is barreling toward a recession.  

Consumption of fuels like diesel could still get a seasonal boost from their usage in industry and agriculture, while government stimulus may also help juice demand, according to industry consultant OilChem. But there’s still ground to be made up. Even before the latest outbreaks, China’s annual crude imports were tracking for a second successive decline as refiners cut back on purchases because of the threat of virus-related shutdowns. Prior to 2021, China’s imports hadn’t fallen since at least 2005.

So, will the confirmation of Xi’s third-term herald a relaxation of the policies that are throttling oil demand?

“I think it’s more complicated than that,” said Michal Meidan, director of the China Energy Research Programme at the Oxford Institute for Energy Studies in the UK. “It will be hard to walk back quickly a policy that has been closely associated with China’s governance system.”

Meidan said it’s difficult to foresee an immediate revival in oil consumption after the congress. “Overall, I think we will see a recovery in Q4 and heading into year-end, but it’s unlikely to be a linear trajectory or a rapid bounce back,” she said.

In the meantime, residents like Wang are wrestling with deep uncertainty over travel that’s sent a chill through their planning, compounded by the need to navigate China’s Covid bureaucracy. After an appeal to a Beijing hot-line, Wang said he managed to get his health code restored to normal after two days -- and he’s willing to try and make the trip to the capital again in coming weeks.

“But to be honest, I still don’t know why I got the pop-up window,” he said.

https://www.bloomberg.com/news/articles/2022-09-06/covid-zero-throttles-china-s-oil-demand-ahead-of-key-congress

Huh? Biden Screams That He 'Beat Pharma This Year'

 by Steve Watson via Summit News,

During a Labor Day speech in Milwaukee Monday, Joe Biden screamed that he “beat pharma this year” despite the fact that he provided billions in record profits for the pharmaceutical industry by attempting to enforce vaccine mandates.

Watch:

Biden repeated the claim at a second speech in Pittsburgh:

A few violent extremists took issue with Biden’s claim:

https://www.zerohedge.com/political/huh-biden-screams-he-beat-pharma-year

FDA seeks wider rollout of international illicit trade alliance

 A pilot between authorities in the US and UK in the fight against illicit and potentially dangerous health products should be extended to other international partners, says the FDA.

Multiple government agencies in the two countries have been working since 2017 on the project – called Operation Lascar – which targets the movement of illicit versions of FDA-regulated products, such as medicines and nutritional supplements.

Now, the FDA says it wants to encourage wide-scale adoption of this approach, and has been meeting with government officials ahead of a workshop to be held in Paris next week (September 15-16) – co-hosted by the Organization of Economic Co-Operation and Development (OECD) – to chart a course forward.

"Criminal networks are increasingly sophisticated and capable of exploiting regulatory, legal, and other gaps to ship and/or tranship illicit and potentially dangerous health products to the US, putting patients at risk," write Cathy Hermsen, FDA's assistant commissioner for criminal investigations, and Ritu Nalubola, director of the agency's Europe office in an update on the programme.

"A series of successful investigations conducted by the FDA's Office of Criminal Investigations (OCI) have demonstrated that the best way to address this problem is to cast a wide net by soliciting the help of other parts of the FDA, other US government agencies, and officials in other countries," they continue.

The work with the UK authorities has resulted in around 80 investigations into criminal networks, revealing how they exploit regulatory, legal, and other gaps to get these products into the US market, and identified more than 3,000 illegal shipments of medicines.

However, an analysis of recent FDA detentions focused on shipments from the EU suggests that bad actors are now using EU member states as transhipment hubs before final shipment to the US, which may be in part a result of Operation Lascar making this more difficult from the UK.

"This latest practice gives criminals the ability to mask all the prior distribution activity, effectively 'restarting' the shipment of illicit products by switching carriers in the EU so that it appears the shipment originated in the EU," according to Hermsen and Naubola.

At the workshop later this month, representatives from the public and private sectors are due to discuss regulatory and legal weaknesses and identify potential whole-of-governments solutions.

For example, in some countries tax authorities may not be able to easily exchange information with customs or the police, and some nations may take different approaches to illicit goods that may make it more difficult to identify the criminal operators.

https://www.securingindustry.com/pharmaceuticals/fda-seeks-wider-rollout-of-international-illicit-trade-alliance/s40/a14739/#.YxfoGnbMLal