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Synthetic Opioid Use Up Almost 800% Nationwide

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Synthetic Opioid Use Up Almost 800% Nationwide

Synthetic opioid use increased by almost 800% over 7 years, new research shows

The results of a national urine drug test (UDT) study come as the US is reporting a record-high number of drug overdose deaths — more than 80% of which involved fentanyl or other synthetic opioids and prompting a push for better surveillance models.

Researchers found that UDTs can be used to accurately identify which drugs are circulating in a community, revealing in just a matter of days critically important drug use trends that current surveillance methods take a month or longer to report.

The faster turnaround could potentially allow clinicians and public health officials to be more proactive with targeted overdose prevention and harm-reduction strategies such as distribution of naloxone and fentanyl test strips.

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Dr Steven Passik

“We’re talking about trying to come up with an early warning system,” study author Steven Passik, PhD, vice president for scientific affairs for Millennium Health, San Diego, California, told Medscape Medical News. “We’re trying to find out if we can let people in the harm reduction and treatment space know about what might be coming weeks or a month or more in advance so that some interventions could be marshalled.”

The study was published online June 3 in JAMA Network Open.

Call for Better Surveillance

More than 100,000 people in the US died of an unintended drug overdose in 2021, a record high and a 15% increase over 2020 figures, which also set a record.

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Part of the federal government’s plan to address the crisis includes strengthening epidemiologic efforts by better collection and mining of public health surveillance data.

Sources currently used to detect drug use trends include mortality data, poison control centers, emergency departments, electronic health records, and crime laboratories. But analysis of these sources can take weeks or more.

Dr Rebecca Jackson

“One of the real challenges in addressing and reducing overdose deaths has been the relative lack of accessible real-time data that can support agile responses to deployment of resources in a specific geographic region,” study co-author Rebecca Jackson, MD, professor and associate dean for Clinical and Translational Research at Ohio State University in Columbus, told Medscape Medical News.

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Ohio State researchers partnered with scientists at Millennium Health, one of the largest urine test labs in the US, on a cross-sectional study to find out if UDTs could be an accurate and speedier tool for drug surveillance.

They analyzed 500,000 unique urine samples from patients in substance use disorder (SUD) treatment facilities in all 50 states from 2013-2020, comparing levels of cocaine, heroin, methamphetamine, synthetic opioids, and other opioids found in the samples to levels of the same drugs from overdose mortality data at the national, state, and county level from the National Vital Statistics System.

On a national level, synthetic opioids and methamphetamine were highly correlated with overdose mortality data (Spearman ρ = 0.96 for both). When synthetic opioids were co-involved, methamphetamine (ρ = 0.98), heroin (ρ = 0.78), cocaine (ρ= 0.94), and other opioids (ρ = 0.83) were also highly correlated with overdose mortality data.

Similar correlations were found when examining state-level data from 24 states and at the county level upon analysis of 19 counties in Ohio.

A Changing Landscape

Researchers said the strong correlation between overdose deaths and UDT results for synthetic opioids and methamphetamine are likely explained by the drugs’ availability and lethality.

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Penn Whitley

“The most important thing that we found was just the strength of the correlation, which goes right to the heart of why we considered correlation to be so critical,” lead author Penn Whitley, BA, senior director of bioinformatics for Millennium Health, told Medscape Medical News. “We needed to demonstrate that there was a strong correlation of just the UDT positivity rates with mortality — in this case, fatal drug overdose rates — as a steppingstone to build out tools that could utilize UDT as a real-time data source.”

While the main goal of the study was to establish correlation between UDT results and national mortality data, the study also offers a view of a changing landscape in the opioid epidemic.

Overall, UDT positivity for total synthetic opioids increased from 2.1% in 2013 to 19.1% in 2020 (a 792.5% increase). Positivity rates for all included drug categories increased when synthetic opioids were present.

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However, in the absence of synthetic opioids, UDT positivity decreased for almost all drug categories from 2013 to 2020 (7.7% to 4.7% for cocaine; 3.9% to 1.6% for heroin; 20.5% to 6.9% for other opioids).

Only methamphetamine positivity increased with or without involvement of synthetic opioids. With synthetic opioids, meth positivity rose from 0.1% in 2013 to 7.9% in 2020. Without them, meth positivity rates still rose, from 2.1% in 2013 to 13.1% in 2020.

The findings track with an earlier study showing methamphetamine-involved overdose deaths rose sharply between 2011 and 2018.

“The data from this manuscript support that the opioid epidemic is transitioning from an opioid epidemic to a polysubstance epidemic where illicit synthetic opioids, largely fentanyl, in combination with other substances are now responsible for upwards of 80% of OD deaths,” Jackson said.

In an accompanying editorial Jeffrey Brent, MD, PhD, clinical professor in internal medicine at the University of Colorado School of Medicine and Stephanie T. Weiss, MD, PhD, staff clinician in the Translational Addiction Medicine Branch at the National Institute on Drug Abuse note that as new agents emerge, different harm reduction strategies will be needed, adding that having a real-time tool to identify the trends will be key to preventing deaths.

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“Surveillance systems are an integral component of reducing morbidity and mortality associated with illicit drug use. On local, regional, and national levels, information of this type is needed to most efficiently allocate limited resources to maximize benefit and save lives,” Brent and Weiss write.

The study was funded by Millennium Health and the National Center for Advancing Translational Sciences. Full disclosures are included in the original articles, but no sources reported conflicts related to the study.

JAMA Netw Open. Published online June 3, 2022. Full text, Editorial

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A Relationship Therapist Ranked the Most Problematic Disney Romances

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A Relationship Therapist Ranked the Most Problematic Disney Romances

Disney romances have long been critiqued for being, well, entirely unrealistic. Not only have animated cartoons set some seriously unobtainable romantic standards for us all, but there are some pretty concerning themes presented in classic children’s movies. Falling in love with a literal vendetta-driven Beast aside—ehm, Belle—consent and logic are often missing from the fictional relationships, not to mention a fairly standard period of getting to know each other before going all in.

So what does a relationship therapist have to say about all this?

In a recent YouTube video, relationship therapist Jonathan Decker analyzed a random assortment of Disney romantic relationships to see which are most problematic and which actually have a solid basis. Testing their partnerships in the battle-royal are animated couples Alladin and Jasmine, Cinderella and Prince Charming, Fix-It Felix and Calhoun from Wreck-It Ralph, Rapunzel and Eugene from Tangled, Simba and Nala from The Lion King, and Snow White and Prince Florian.

Out of the selected couples, Decker ranks Snow White and Prince Florian (yes, the prince as a name — and it apparently is that) as the most problematic pairing. After all, the two meet only once (without talking!) before betrothing themselves to one another with Snow White becoming so scared during that meeting that she literally runs away.

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So this is love? Well, maybe not.

“Snow White, you are experiencing a chemical rush that is probably a combination of responding to his pheromones and being physically attracted to him, and the adrenaline of absolute terror,” Decker says. “So those things combined can be kind of potent. Doesn’t mean it’s love.”

That’s all not to mention the little (or, rather, absolutely blatantly massive) issue of consent in their relationship — or lack thereof.

Decker says, “[Snow White] eats the poison apple, she gets knocked out, and then he sees her and is like, ‘I should totally kiss that.’”

Now, remember, Prince Florian has absolutely no idea a kiss will save Snow White from the poison. As Decker says, he just stumbles upon her unconscious and thinks “now’s my window.”

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Obviously, the vintage Disney couple is outdated and problematic by any standards — but what about the least problematic couple of the bunch? Decker says Fix-It Felix and Calhoun from Wreck-It Ralph actually have a relationship to envy, creating a dynamite team and embracing each other’s personalities.

“They accept influence from each other,” Decker says. “On the surface, [Calhoun] is tough, no-nonsense, leads troops into battle — and Felix seems like this really sweet, kind of derpy, doesn’t-really know what he’s doing guy. But she accepts influence from him, he definitely accepts it from her all throughout, and they complement each other. It’s like salty and sweet.”

Though the two may win all-or-nothing video games with their complemenary personalities and differing approaches, they also make each other grow and flourish in their relationship.

“She softens because of his influence, and he toughens up because of her influence,” Decker says. “And there’s kind of a meeting in the middle.”

Curious to find out where the other couples land? Watch the full video above to see get the entire definitive ranking.

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Former MLB Pitcher Kyle Farnsworth Is an Absolutely Shredded Bodybuilder Now

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Former MLB Pitcher Kyle Farnsworth Is an Absolutely Shredded Bodybuilder Now

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Brace HemmelgarnGetty Images

You may know Kyle Farnsworth for his 17-year Major League Baseball career spanning from 1999 to 2014. Though the 46-year-old former pitcher left the major leagues in 2014, he hasn’t let his love of fitness falter. In fact, Farnsworth is now an absolutely jacked bodybuilder in his “retirement.”

Once sporting a relatively-slim baseball player physique, Farnsworth recently captured headlines for his status as a bludging competitive bodybuilder. In a recent YouTube video, Athlean-X trainer Jeff Cavaliere broke down Farnsworth’s incredible physical transformation—and why it may not be as surprising as it seems.

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“No doubt, he looks like an absolute beast,” Cavaliere says of Farnsworth’s current physique. “The vascularity is sort of crazy, the size is ridiculous, the legs are absolutely shredded and humongous…Basically, Kyle Farnsworth is a big, jacked dude.”

At 6’4″ and currently 240 pounds, Cavaliere says Farnsworth has always had bodybuilding potential from a genetic standpoint, adding that he was also “one of the hardest workers in the room,” giving him the ability to capitalize on the hereditary leg-up.

“He was an anomaly when it came to baseball players, especially as a pitcher,” Cavaliere says in the video. “His size and his overall appearance were not what you would typically see. So he was always big.”

Cavaliere, who worked for the Mets from 2006 to 2008, was with the New York-based team at the same time that Farnsworth played for the Yankees. The trainer said he personally would see the pitcher “cranking out” countless leg extensions before any other players showed up on game day, showing his bodybuilding potential several years ago.

“I didn’t really see that as being the best, most functional way to train for his sport. Step-ups, lunges — there are better things that he could do,” Cavaliere said. “But he did a lot of leg extensions, so the fact that he’s now become a bodybuilder certainly doesn’t surprise me at all because I always wondered if he was more interested in bodybuilding versus pitching.”

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Cavaliere also mentions the possibility of performance-enhancing drugs playing a role in the transformation, though the speculation is just that — entirely speculation. Yet, the trainer says performance-enhancers were a reality of the baseball era Farnsworth played in, citing that the former pitcher was on the receiving end of some PED rumors during his major league tenure.

During his time in the major leagues, the pitcher played for several teams from 1999 to 2014. He signed with the Chicago Cubs in 1999, playing with the team until 2004. He was then traded to the Detroit Tigers in 2005, then traded again to the Atlanta Braves later that same year. Farnsworth signed with the New York Yankees in 2006, playing with the team until 2008. In 2008, he was traded back to the Tigers, but swiftly signed to the Kansas City Royals from 2009-2010. In 2010, Farnsworth was traded back to the Braves, then signed with the Tampa Bay Rays from 2011 to 2013. In 2013, he traded to the Pittsburgh Pirates, then to the New York Mets in 2014. He wrapped up his MLB career with the Houston Astros in 2014.

You can watch the entire video below:

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‘Pam and Tommy’ Originally Wanted Chris Evans to Voice Tommy Lee’s Penis

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‘Pam and Tommy’ Originally Wanted Chris Evans to Voice Tommy Lee’s Penis

If a penis could talk, what would it sound like? That’s the burning question creators of Hulu’s Pam & Tommy had to grapple with when creating the now-infamous talking penis scene in the biopic series.

Well, according to Sebastian Stan, who stars as Tommy Lee in the series, the show’s creative team originally thought Lee’s penis would sound something like Chris Evans.

In a recent interview with Awards Daily, Stan revealed that he shot the comedic yet vulnerable scene not knowing who would voice the prosthetic appendage.

“He actually wasn’t there on the day,” Stan told the outlet. “We didn’t know who we were going to get at that point. The guys, I think, called me at one point and were like, ‘What do you think? Do you think Chris Evans would do this with you?’ And I was like, ‘I’m not calling him, OK?’”

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Just consider it: Captain America voicing Bucky Barnes’ penis? What in the MCU multiverse…

Eventually, the role ended up going to Big Mouth and Brooklyn Nine-Nine actor Jason Mantzoukas, whose delightfully brash voice is inarguably perfect for Tommy Lee’s sentient penis.

In a February interview with Entertainment Weekly, showrunner Rob Siegel revealed some of the inner workings of creating the oddly captivating scene with a puppet-like animatronic penis, which was created from a lifecast of Stan’s actual appendage.

“I can’t think of a more fun and cuddly way to get away with extended full-frontal male nudity,” Siegel said. “It’s a puppet, it’s like Yoda.”

To get a seamless look that makes it appear like Stan is standing nude and not with a puppet hanging from his member, the SFX team used a lot of glue (ouch) and paint to secure and blend the appendage.

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“There were wires running between his legs from behind, and a guy crouched on the floor with joysticks, mechanically controlling what’s going on,” showrunner D.V. DeVincentis told Entertainment Weekly. “That animatronic guy had to look in a mirror and sort of really act with Sebastian physically, like all the gestures and the nods and looks up, and we had to actually direct that. I’ve never done anything quite like that.”

Truly, that’s not surprising.

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