Treating major depressive disorder remains an important challenge worldwide. The disorder impairs productivity, social functioning, and overall health, reducing life expectancy and burdening health care systems.1 Although many treatments exist, at least a third of patients do not have a response after two or more trials of antidepressant drugs and are considered to have treatment-resistant depression.2 Such patients have an increased risk of suicide relative to both the general population and patients with nonresistant major depressive disorder; at least a third of them attempt suicide.3 

The FDA recently approved the S-enantiomer of ketamine, esketamine, a rapidly acting drug shown to be effective in patients with treatment-resistant depression.

Balancing these potential risks with the benefits of an effective drug for a serious disease for which there is substantial unmet need, the FDA approved esketamine with a Risk Evaluation and Mitigation Strategy (REMS). The intent of the REMS is to mitigate the risk of serious adverse outcomes resulting from sedation, dissociation, and abuse and misuse, while providing access to this effective treatment for treatment-resistant depression. Esketamine will be dispensed and administered to patients only in a medically supervised health care setting where they can be monitored for adverse reactions for at least 2 hours; pharmacies that dispense esketamine must ensure that the drug is dispensed only to clinics and hospitals that are certified in the REMS.

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Published 22.5.19

Australians have access to mass amounts of potent drugs online, equivalent to "billions of doses" every day, according to a new study from The Australian National University (ANU).

The report found "alarming" amounts of synthetic opioids such as fentanyl and carfentanil available on the dark web. 

Carfentanil is not for human use and was originally designed to sedate elephants. 

The researchers say the report lifts the lid on a significant new synthetic opioid market on the dark web. 

"We are on the brink of a new opioid epidemic driven by synthetics like fentanyl and carfentanil that are driving a greater risk of overdose deaths," said lead author Professor Roderic Broadhurst, from the ANU Cybercrime Observatory.

"Fentanyl is a designer synthetic opioid about 100 times more powerful than morphine," said Professor Broadhurst.

"The average dose of fentanyl is 200 micrograms. We found millions of doses of fentanyl available to buy every day.

"Carfentanil is 10,000 times more powerful than morphine and there are alarming amounts of it available online." 

"We were shocked by the amount of Carfentanil we found. Billions of doses are available online on any day." 

Professor Broadhurst says fentanyl is being used by criminal networks to lace heroin and create synthetic heroin that is changing the landscape of narcotic sales.

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(February 4, 2019)

• The importance and efficacy of Prevention & Demand Reduction mechanisms
• Focusing on the real dangers of Marijuana, Kratom and E-Cigarettes (Vaping)

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Conclusions: These results show that subacute exposure to amphetamines is associated with an advancement of cardiovascular-organismal age both over age and over time, and is robust to adjustment. That this is associated with power functions of age implies a feed-forward positively reinforcing exacerbation of the underlying ageing process.

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Progression from first use to use disorder on alcohol, cannabis, stimulants, sedatives and opioids

Highlights

• Pre-existing mental disorders increases the risk of developing SUD.
• Prior SUD increases the risk of transitioning from use to use disorder.
• Highest rates of transition to SUD occurred among stimulant and opioid users.
• Mood and anxiety disorders increased the risk of transitioning to AUD and CUD.
• The rapidity of transition to SUD emphasizes the narrow opportunity to intervene.

Conclusion: The relative speed associated with the transition from use to SUD emphasizes the narrow window of time available to intervene, underscoring the urgency of early identification of mental health conditions and the timely provision of appropriate evidence-based interventions, which could potentially prevent the development of secondary SUDs.

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