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Tiny capsules containing cannabinoids could help treat neurological disorders

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A team of researchers led by Curtin University has discovered a new way to improve the rate of oral absorption of medical cannabis, which could potentially be used in the future to treat neurological conditions such as Alzheimer’s disease, multiple sclerosis and traumatic brain injuries.

Photo credit: Curtin University

Published in the journal PLOS ONE and financed by industrial partner Zelira Therapeutics, the researchers were able to produce tiny capsules with cannabinoids that were absorbed faster by the body when taken orally and penetrated the brain more quickly in mouse models with neurological diseases than when it was supplied in liquid form .

Lead researcher, Associate Professor Ryu Takechi of the Curtin Health Innovation Research Institute (CHIRI) and Curtin University’s School of Population Health, said there is growing interest in the use of cannabidiol to treat various neurological disorders, but there are limitations due to it its poor absorption and sensitivity to light and gastric acid when taken orally.

“Cannabidiol occurs in medical cannabis and is a popular natural remedy for people with neurological and metabolic diseases. Due to limitations in absorption, we wanted to develop and test a new method of drug delivery, ”said Professor Takechi.

“Our team was able to significantly improve the absorption and release of cannabidiol in the brain by administering it in a novel microcapsule form in combination with a naturally occurring bile acid.

“With this new capsule shape, we were able to remarkably improve the release of cannabidiol in the brain in animal models by 40 times and we were also able to protect the drug from oxidation and degradation by light, which extends the shelf life of the product.”

Associate Professor Takechi said the results could be helpful to support the clinical use of medicinal cannabis in the treatment of neurological disorders.

“In this study we were able to show for the first time that a bile acid actually increases the absorption and retention of cannabidiol in the brain. This shows that bile acids could be used to improve the intake of cannabidiol when taken orally, particularly in the treatment of neurological disorders, ”said Professor Takechi.

“More research is needed to test whether this type of drug delivery could be successful in human studies, but our results are very promising.”

Dr. Oludare Odumosu, CEO of Zelira, said he was very pleased with the outcome of working with Associate Professor Takechi and his team.

The new encapsulation technology appears to significantly improve the efficiency with which cannabinoid-based drugs can be transported into the brain. This could improve the effectiveness of cannabinoid therapies in treating neurological disorders while reducing costs and increasing safety. “

Dr. Oludare Odumosu, CEO, Zelira

This research was a joint effort by researchers from CHIRI, Curtin Medical School, and the School of Population Health at Curtin University, the University of Newcastle and the University of Otago.

The full paper entitled “Sodium Alginate Microencapsulation Improves Short-Term Oral Bioavailability of Cannabidiol When Administered with Deoxycholic Acid” can be found online here.

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Journal reference:

Majimbi, M., et al. (2021) Sodium alginate microencapsulation improves the short-term oral bioavailability of cannabidiol when administered with deoxycholic acid. PLUS ONE. doi.org/10.1371/journal.pone.0243858.

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How psychedelic-assisted therapy with MDMA and psilocybin works

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Investors open their minds and their wallets to the possibilities of psychedelic therapies.

Three biopharmaceutical companies that aim to manufacture psychedelic drugs for the treatment of mental disorders have gone public in the past few months: Peter Thiel supported Atai Life Sciences’ IPO in June and now has a market capitalization of $ 2.6 billion; MindMed went public in April and now has a market capitalization of more than $ 1 billion; and Compass Pathways went public in November, with a current market cap of nearly $ 1.5 billion.

Together, the three companies have more than nine psychedelic therapy drugs in their pipeline. Not to mention the work of many other private biotech and telemedicine companies like Gilgamesh Pharmaceuticals, which is supported by Y Combinator, as well as startups like Mindbloom, which already treats patients with ketamine-assisted psychotherapy. (Ketamine is not a psychedelic, but is considered a dissociative anesthetic that can distort vision, colors, sounds, self and surroundings).

All of this means that triggering mind altering drugs like MDMA could become a regular part of therapy for treating conditions like depression, post-traumatic stress disorder, addiction, chronic pain, and obsessive-compulsive disorder over the next two to five years.

This is what it could look like and what the research says.

How psychedelics work for therapy

Psychedelics are substances that change perception and mood and influence a number of cognitive processes. The classic psychedelics include MDMA, also known as “Ecstasy” or “Molly”, LSD, psilocybin or “mushrooms”, Ayahuasca and Ibogaine.

Working with therapists, research has shown that psychedelics can help treat conditions historically difficult to treat by essentially “transforming” the way “parts of the brain talk to each other,” said Jennifer Mitchell, neuroscientist and professor in the Departments of Neurology, Psychiatry, and Behavioral Sciences at the University of California San Francisco.

Researchers provide therapeutic support in the treatment room of one of the study centers for MAPS-sponsored clinical trials of MDMA-assisted therapy for PTSD.

Courtesy of MAPS.

“Psychedelics allow processing in a way that allows subjects to let go of things that previously plagued them,” she says.

As Mitchell explains, your brain goes through critical periods of learning and development at a young age, which then close as you age. Researchers believe that psychedelics “only open these closed critical periods for a tiny window of time,” she says.

“When this critical period is open again, you want to make the most of it and make this potential change as positive as possible,” she says.

For example, with psilocybin the drug is believed to increase connectivity in the brain and increase “neuroplastic states,” which are the brain’s ability to reorganize and adapt, says Dr. Stephen Ross, Associate Professor of Psychiatry at NYU Grossman School of Medicine, who has conducted clinical trials in psilocybin-assisted therapy for 16 years.

For example, a recent study from Yale University on mice found that a single dose of psilocybin caused an immediate increase in connections between neurons that lasted a month afterward.

When taking psychedelics, “parts of the brain that don’t normally talk to each other begin to communicate with each other, and it seems to reset brain patterns in some way,” he says.

What psychedelic therapy looks like: “It’s not a Burning Man”

MDMA-assisted therapy could be approved for medical use by the FDA as early as 2023, while other psychedelics, particularly psilocybin, are waiting in the wings for their turn for medical use.

If and when psychedelic assisted therapy is approved by the FDA, it will be far more complex and medical than just someone taking mushrooms for recreation in the woods.

“You don’t just get thrown in,” says Mitchell. “It’s not Burning Man or anything. It’s very thoughtful.”

First, patients need to be carefully screened to be eligible.

“It’s not for everyone,” says Dr. Corine de Boer, Chief Medical Officer at the Multidisciplinary Association for Psychedelics Studies, a nonprofit research and educational organization. For example, treatment is not suitable for people with a history of psychosis or cardiovascular problems. (And right now, psychedelics aren’t being studied in people with milder mental illnesses or people without clinically diagnosable conditions.)

For those who qualify, psychedelic assisted therapy sessions will “be a synergy between the participants, the therapist and the medication,” says de Boer.

Research-grade capsules for use in MAPS-sponsored clinical trials of MDMA-assisted therapy for PTSD.

Courtesy of MAPS.

Before any medication is administered, doctors meet the patient to discuss what might happen to them – for example a traumatic event or painful memories from childhood, or, in the case of a terminally ill patient, they can check how the disease has affected them Has affected life.

The sessions in which the patient takes psychedelic medication can be quite labor-intensive and long (around eight hours), says Mitchell. A single dose of MDMA will work for six hours and half a dose will be given approximately 90 minutes after the session begins.

To provide patients with a comfortable travel environment, providers set up a room that resembles a living room or bedroom and give patients an eye mask and a playlist of soothing music before taking the medication. Patients are invited to “go inside” and reflect on the issues they discussed in the preparatory sessions.

“Whatever comes up for them is what medicine is based on their own history and [brain] Circuit, “says Mitchell.

Patients can talk about the issues that arise, and the therapists are there to help them accept and listen to any ideas that come to the surface rather than asking questions. “As you can imagine, there are a lot of emotions,” says Mitchell.

Patients are conscious and can comfortably eat, drink, and use the toilet, but are accompanied by two staff members when they stand or walk, Mitchell explains.

The next day there is an “integration session” in which the therapists talk to the patient and help him understand what he has experienced. The patient could return to the reasons why they did the treatments in the first place and, for example, discuss what they felt or saw during the experience.

Mitchell says an important transformation occurs when people take psychedelics in this clinical setting. “It’s amazing how much lighter and freer people seem to be after the first session,” she says.

In fact, in a recent MDMA study, depression was relieved or significantly reduced after three doses given about a month apart.

It is to be expected that these treatments will be covered by the health insurance at some point. Obtaining insurance to cover treatment also depends on the compounds being moved from their current classification as List I Medicines under the Controlled Substances Act. (Experts believe MDMA could be postponed in the next two years.)

Of course, the treatment carries risks. Psychedelic therapy is not recommended for people with psychotic disorders and people with high blood pressure. Outside of a clinical trial, many psychedelics, such as psilocybin and MDMA, are classified as Schedule I drugs under the Controlled Substances Act.

But “in the next three to five years psychiatry will change profoundly” with psychedelic-assisted therapy, says Ross.

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‘My daughter, 13, went missing from hospital – she’s in crisis waiting months for a mental health bed’

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Earlier this week, Emma Shepherd received the phone call she was afraid of. A nurse called at 8 p.m. last Tuesday and told her not to worry, but her 13-year-old daughter, Lila Veasey, had escaped from the hospital.

“She is so vulnerable,” she said. “I was so concerned and thought that in her weak condition it could be very dangerous to run in this heat and risk becoming dehydrated.”

After four hours of desperate search as darkness fell, the barefoot Lila was found “terrified, shaken and very upset” three miles from Sheffield Children’s Hospital.

It is the first time the young woman has been able to escape, but she has made several attempts in the past three months – that is how long she was in sections, waiting for a special bed. Three months without tailor-made treatment for her eating disorder, anorexia.

When Lila was first admitted in April, she was ready to eat. But when the doctors tried to increase her food, she refused meals and started screaming and locking herself in toilets.

You can’t just tell them to eat. Lila needs the specialized psychological support

She then had to be force-fed food and even water through a hose. She was taken from the ward along with other youths and taken to her own room with a private bathroom. Visits outside in kindergarten were forbidden.

“She is isolated and locked in her room 24/7 and is going mad,” said Emma. “Any parent of a child with an eating disorder will tell you that you can’t just tell them to eat. Lila needs the specialized psychological support alongside her food, but it’s just not there and that’s why she went downhill. “

Lila was found on her bare feet three miles from Sheffield Children’s Hospital (Photo: Emma Shepherd)

Children in crisis

Emma, ​​33, from Sheffield would like to point out that it is not the hospital staff’s fault. “They are doing their best, but the nurses are not trained in mental health.

“CAMHS [Child and Adolescent Mental Health Services] needs more money from the government at the national level. We need more special forces.

“Since sharing my experience online, I’ve received hundreds of messages from parents in a similar boat, so many that I can’t find the time to reply. It’s heartbreaking. “

Indeed, recent figures show a worsening crisis in child mental health services. Even before the outbreak of the pandemic, up to half of all young people called for help were left without adequate support.

The latest figures from NHS Digital show that in 2019-20, 23 percent of the 547,590 under 18s who relied on the NHS mental health, learning disability and autism services had no contact with health workers. For another 26 percent – 144,384 people – the referral was closed without treatment.

The 13-year-old struggled with being locked in a hospital room for months (Photo: Emma Shepherd)

And during the pandemic, the demand for mental health services for young people has risen sharply. Earlier this month, it found that referrals increased by a third in 2020-21 compared to 2019-20.

Parents flood social media groups with stories of how their children – even those with severe psychiatric problems, including or talking about self-harm or attempted suicide – are not getting the proper support.

The number of young people with eating disorders hospitalized in England has increased during the lockdown – the number of under-20s admitted last year topped 3,200, nearly 50 percent more than in 2019-20 .

“She must be in a safe unit”

What really frustrates mom of three Emma is that she began seeking action for her daughter from an early age in her illness.

Lila had started showing signs of eating disorders in January and when it became more noticeable in March, she sought help from her family doctor. “She started to refuse family meals and only ate salad and fruit,” said Emma, ​​a beautician. “She was called fat and was obsessed with weight loss videos on TikTok.

“When it got worse and I took her to the doctors, she collapsed and told him she had only eaten 400 calories a day. She confessed that she starved at school all day.

“He was concerned that she was underweight and wanted her to come back in a few weeks for a review. But at that time she was not offered any advice. “

Weeks later, Lila stopped eating altogether for five days, and then her parents took her to the hospital.

Emma calls for more urgent funding for mental health services (Photo: Emma Shepherd)

“She tries to escape from the hospital every day, she has to be in a safe ward,” said Emma. “She only gets counseling once a week while she gets it maybe four times a week and other activities to help her eating disorder if she had a CAMHS internship.”

Sheffield Children’s Hospital said that inpatient beds for patients with conditions like Lila are scarce across the country and that the national CAMHS, through NHS England, is responsible for allocating those beds.

She has deteriorated drastically and she might not have done it if she had got help

“Lila asks me every day: ‘When will I get a bed?’ And I never have good news to tell her. I was told she could get one in September, but that’s not early enough and it’s not even a guarantee.

“She has gotten drastically worse and she might not have made it if she had got help. We tried to enable them to intervene early. I feel hopeless, it affects the whole family. “

Family friend Rebecca Grafton set up a GoFundMe page to help Lila’s parents raise money for private therapy.

£ 79m pledged to support the mental health of adolescents

The government announced in March £ 79 million in support of child and adolescent mental health.

The funding will increase the number of mental health support teams in schools and colleges from 59 to 400 by April 2023 and support nearly three million children.

Access to community mental health services will also be expanded, so that 22,500 more adolescents will have access to help and support – including conversational therapy and cognitive behavioral therapy – between 2021 and 2022. And 2,000 more will benefit from help for eating disorders.

However, health chiefs warn the immediate effects of lockdowns need to be addressed, with the NHS England pledging an additional £ 40million in services earlier this month.

A Health and Welfare Department spokesman said: “We understand the importance of early intervention and treatment and are allocating an additional £ 2.3 billion a year to mental health services through 2024 – the largest mental health funding in the history of the NHS .

“At the same time, our £ 500 million intergovernmental mental health restoration action plan is specifically targeting people and groups hardest hit by the pandemic. This includes £ 79 million to accelerate and expand the delivery of mental health services to children and adolescents.

“To make it easier for people to access the right support, the NHS is introducing a four-week waiting period for mental health treatment of children and adolescents in 12 areas of England, to give government recommendations on access and waiting time standards.”

I’m really sorry for the hospital

Sheffield Children’s Hospital said it was working closely with NHS England to find a suitable place for Lila’s care.

Sally Shearer, Director of Nursing and Quality, said, “We are really sorry that what happened on Tuesday caused Lila’s family to be in distress. We have reviewed the incidents and are identifying measures to prevent another situation of this kind in the future. We continue to do our utmost to ensure the safety and well-being of all children and young people in our care.

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Exercise addiction affects more people and can lead to eating disorders – but counseling can help

“We want to assure families that we take safe staffing very seriously. The high rates of Covid infection the country is currently experiencing mean that we currently have more colleagues who need to self-isolate, but shifts are covered by other colleagues and qualified temporary workers and we have been able to keep the workforce consistent.

“We understand that it is incredibly worrying for families waiting to find a suitable place for their child. Work is ongoing across the country to provide more places for children and adolescents in need of expanded support, but in the meantime our clinical teams are working hard to provide the best possible care in the children’s hospital. “

Do you have a real life story? Email to claudia.tanner@inews.co.uk.

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Despite barriers, telemedicine provides a lifeline for patients seeking mental health care during pandemic

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“You don’t have enough effort to say, ‘You’re just thinking wrong.’ That won’t allow you, ”said Bastin, who works as a data specialist for the Minnesota division of the National Alliance on Mental Illness. “If you have severe depression, you can tell yourself all sorts of things.”

In the early months of the pandemic, Bastin’s therapist did not offer face-to-face sessions in her Minneapolis office, which is where Bastin is based. During this time, Bastin’s mental state deteriorated significantly. Eventually, she was able to see her therapist remotely through a video telemedicine system – a resource she believes was potentially life-saving.

Sharon Bastin, who works as a data specialist for the Minnesota branch of the National Alliance on Mental Illness, received telemedicine care for her mental illness. She sees the service as potentially life-saving. “If you have major depression, you can talk yourself into anything,” she said. (Courtesy Sharon Bastin)

Behavioral and mental health treatment was ahead of other specialties in terms of telemedicine use prior to the pandemic, but patients have still increasingly turned to these services over the past year.

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One study found that telemedicine coverage for mental illness or substance abuse increased from 1% of pre-pandemic visits to 41% in October 2020.

For most people providing and receiving medical care, the escalated adoption of telemedicine is one of the silver lining amid the devastation of the pandemic. The funds flowing into the technology reflect their increased commitment. According to an analysis by management consultancy McKinsey & Company, investments in telemedicine technologies were higher in the first half of 2021 than in all of 2020.

While the benefits of telemedicine have been particularly appreciated by people with physical disabilities or mental illnesses, telemedicine has also created new barriers for users at a time when medical assistance was vital.

A stress-saving lifeline

For over a year, Alexi’s fear kept her from driving. The Rochester resident, who asked to only use her first name, felt relieved to be able to remotely treat her mental illness during the pandemic.

“That saved me the added stress of being on time for an appointment,” she said. “I could just sit comfortably at home and just click on my computer.”

The accessibility benefits for people with mental illness are enormous, said Sue Abderholden, executive director of the Minnesota Chapter of the National Alliance on Mental Illness.

“Access was much more convenient than before,” she said.

A NAMI survey found that telemedicine visits made a connection at a time when people were starving for it, especially when struggling with mental illness.

“It’s great that I can connect to services right from home. The ability to continue to be in visual communication with my therapist during the most isolated days / weeks of this pandemic was crucial. Nice to see people without masks! ”Wrote one interviewee.

Several respondents stated that they appreciate the relief of not having to worry about transportation for personal appointments. Others wrote that they believed it was the safest option for themselves and their families during the pandemic, and it allowed them to stay in comfortable surroundings on days when they were not comfortable.

“Love it! Days on which I would cancel because I don’t feel up to an appointment, I would keep (the) appointment because I can use telemedicine,” wrote another respondent.

Providers of all specialties have seen fewer missed appointments for those cared for through telemedicine during the pandemic, Abderholden said.

Technological barriers

For a troubling week in May 2021, Alexis lost her access to telemedicine when her computer stopped working.

“I noticed that I was getting a little more excited and nervous,” she said after missing several appointments, which could have affected her ability to refill prescriptions.

Alexis turned helplessly to the Southeastern Minnesota Center for Independent Living. The SEMCIL team offered those in need a depot with 20 iPads and 50 Chromebooks during the pandemic, mostly powered by CARES Act dollars.

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“The intent would be to help with social isolation,” said Chanell Calhoun, SEMCIL’s independent supervisor of residential programs and an assistive technology specialist. She added that some used the tablets to connect with family members or attend virtual workshops, but many used the tablets to gain access to medical care.

When Alexis used her iPad to fill in the gaps when her computer went down, it gave a sense of support at a time when she felt very alone.

“You are more isolated; you feel like you’re on your own and somehow spin, ”she said.

While some patients were able to find solutions to their technological problems, others were left stranded.

“The elders and children are the ones who have likely lost the most ground in terms of the pandemic and the move to telemedicine,” Abderholden said.

A survey conducted by the Minnesota Department of Health also found that these groups are hardest hit by technological barriers.

Elderly patients seeking treatment for a mental illness often encountered technological problems and sometimes did not access their telemedicine services until a provider guided them through downloading the software. Some users have stuck with audio-only services, a lifeline for those living in areas with poor internet access.

Even for tech experts, telemedicine posed a different problem: screen time burnout.

School-age children who spent all day in front of their computers taking distance learning often did not feel like dealing with emotional problems in the same setting.

“The technology worked fine, but my kid got burned out doing everything on video and started to end the sessions early. However, I’m not sure how to improve engagement, ”wrote one respondent to the NAMI survey.

There were also privacy concerns for people who shared rooms with family members and couldn’t find a discreet area to openly express their problems with a psychologist. Bastin found that she moderated what she said and when she logged into her therapy sessions in the privacy of her room because she feared family members would hear through the walls.

“It’s not soundproof. So if you talk too loud, they will hear you. But I would still rather have that and speak to my therapist than sit there with my own depression and talk myself into stupid things, ”she said.

Long lasting changes

Minnesota has had a Telehealth Act since 2015, which was passed after long discussions between patients and providers about cost, fraud and quality.

“We have the law on the books that health plans, you have to cover telemedicine when medically appropriate, and you have to pay what you would have paid if this service were personal,” said Dave Renner, Advocacy Director for the Minnesota Medical Association.

For years, proponents have tried to ease restrictions on access to telemedicine. When the pandemic sparked widespread use of telehealth services, legislative changes eventually followed.

The location at which patients are entitled to telehealth services was expanded in spring 2020 as part of the emergency power permit and enables home care and not just inpatient or clinical care. A second change allowed for audio-only coverage, a shift from previous regulations that limited telemedicine visits to video.

Laws passed in June 2021 under the Health and Human Services Bill made these changes part of the law rather than just part of the Emergency Authorization Declaration. The coverage of pure audio services is still questionable due to concerns about the quality of supply, said Renner, but it is protected for at least the next two years.

Doctors in the region hope that telemedicine will remain an integral part of medical care even after the emergency services created in the wake of the pandemic have been relaxed. There are always populations that can benefit, especially people with physical disabilities, said Dr. Steve Ommen, cardiologist and experiential medical director for the Center for Digital Health at the Mayo Clinic.

Mayo Clinic cardiologist Dr.  Steve Ommen.  (Photo of the post bulletin file)

Mayo Clinic cardiologist Dr. Steve Ommen. (Photo of the post bulletin file)

“It doesn’t matter where you live if getting out of your house is a challenge. Then it will be much easier for these people to connect with your doctor or nurse who is administering care and do so from the comfort of their own home, ”he said.

Regardless of its benefits, Ommen emphasized that telemedicine is probably best used in combination with personal care.

“We believe that virtual telemedicine care will be integrated with on-site care and will move smoothly between them depending on the needs of the patient at that point in time,” he said.

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