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NIH Exec: Research Offers Opioid Crisis Solutions

Nora Volkow

Nora Volkow at the AAAS annual meeting, 16 February 2018 (A. Kotok)

16 February 2018. The director of the National Institute on Drug Abuse says recent research in neuroscience and pharmacology reveals possible pathways out of the current epidemic of opioid addiction and overdose deaths. Nora Volkow, director of NIDA, part of National Institutes of Health, since 2003 presented her remarks today during the 2018 American Association for the Advancement of Science (AAAS) annual meeting in Austin, Texas.

Volkow outlined the distressing and startling statistics on opioid addiction, showing the number of opioid-related overdose deaths increasing rapidly in recent years. In 2016, according to data from Centers for Disease Control and Prevention, some 64,000 people in the U.S. died from opioid overdoses, of which more than 20,000 of those fatalities involved the synthetic opioid drug fentanyl. The problem is also now nationwide, where in 1999, high rates of overdose deaths occurred in isolated pockets of the U.S., such as the Appalachian region and New Mexico.

The problem of opioid addiction, says Volkow is closely interrelated with the management of pain. Too many medical practitioners, she notes, became overconfident that medications were safe. But as negative consequences of opioids began piling up, she notes, it became clear “opioids are not a panacea for pain, particularly chronic pain.”

Studies of opioids’ activity in the brain point out the drugs’ potential dangers. Opioids target mu opioid receptors in the brain that signal neurons reacting to pain, but also to pleasure and rewards. Regions of the brain dealing with pain are found near the nucleus accumbens, the site that regulates reward behavior and involved in reinforcing addictions.

While control of pain may have instigated the opioid crisis, says Volkow, illicit drugs are now sustaining and exacerbating the problem. One of those drugs is heroin, for which overdoses were relatively stable until 2010. Pure heroin from Mexico, however, is now less expensive that prescription opioid drugs, notes Volkow, enabling people addicted to prescription opioids  to maintain their habits at lower cost. Some 70 percent of people addicted to heroin, adds Volkow, started with prescription pain medications. And because of fentanyl’s potency — some 500 times more than heroin — it is easy to hide and transport in small quantities.

Routes out of crisis

Volkow discussed findings from research on current drugs to treat opioid addiction that show promise in breaking the addiction syndrome. Buprenorphine is a partial stimulator of opioid receptors, which when used as part of a treatment program, can help reduce cravings and withdrawal symptoms in people with opioid addictions, and in turn reduce their use of addicting opioids. Natrexone completely blocks the rewarding effects of opioids, and is also used as part of treatment programs when people with addictions can first fully withdraw from opioids.

Studies of these drugs, says Volkow, have encouraging results. Findings from research among people visiting community health centers, admitted to emergency rooms, or in the criminal justice system show simple interventions can reduce overdose deaths, criminal activity, and the spread of infectious diseases. The problem with these medication-assisted therapies is they’re underused, often because of the stigma in admitting an addiction.

Other treatments in development, notes Volkow, are addressing some of these complicating issues. Extended release forms of buprenorphine and natrexone, for example can help ease the problem of adherence to daily drugs. In addition, biologic therapies, such as vaccines, are being developed to produce antibodies that invoke the immune system to prevent fentanyl from getting into the brain. Another promising approach is non-pharmaceutical treatments, such as neurostimulation, to relieve pain.

In response to a question from Science & Enterprise, Volkow says actions by some states to cut back or restrict access to Medicaid may not directly affect treatment for opioid addiction. The more fundamental problem, Volkow notes, is gaining any reimbursement for opioid addiction therapies, from commercial insurance plans or Medicaid, forcing people with addictions to completely fund their treatments.

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