All Scientific Hands on Deck to End the Opioid Crisis
Posted on by Dr. Nora Volkow and Dr. Francis Collins
In 2015, 2 million people had a prescription opioid-use disorder and 591,000 suffered from a heroin-use disorder; prescription drug misuse alone cost the nation $78.5 billion in healthcare, law enforcement, and lost productivity. But while the scope of the crisis is staggering, it is not hopeless.
We understand opioid addiction better than many other drug use disorders; there are effective strategies that can be implemented right now to save lives and to prevent and treat opioid addiction. At the National Rx Drug Abuse and Heroin Summit in Atlanta last April, lawmakers and representatives from health care, law enforcement, and many private stakeholders from across the nation affirmed a strong commitment to end the crisis.
Research will be a critical component of achieving this goal. Today in the New England Journal of Medicine, we laid out a plan to accelerate research in three crucial areas: overdose reversal, addiction treatment, and pain management [1].
First, there is a need to develop additional overdose-reversal interventions and improved formulations of naloxone to reduce mortality. Naloxone is very effective at reversing overdoses, but bystanders may not reach the person in time and the usual doses given may not be powerful or long-lasting enough to reverse overdoses on fentanyl and other highly potent synthetic opioids. In addition to new or differently formulated antagonists of the mu-opioid receptor, other targets such as the 5HT1A receptor (a serotonin receptor) may hold promise as alternative ways of reversing respiratory depression caused by opioid overdose.
Research is also needed to develop technologies that can detect an overdose and signal for help as well as intervene automatically to stimulate respiration. We must also develop better strategies to effectively engage people who have overdosed in addiction treatment.
Second, we need new, innovative medications and technologies to treat opioid addiction. The existing opioid agonist (methadone), partial agonist (buprenorphine), and antagonist (naltrexone) medications effectively reduce illicit opioid use when they are provided at a sufficient dose and patients adhere to their treatment plan—but not all patients respond to these medications.
Our growing knowledge of the neurobiology of opioid addiction has helped researchers to identify novel molecular targets (such as the kappa-opioid receptor and serotonin receptors) and new ways of modifying brain circuits that may produce more effective and safer treatments for opioid use disorders. Among the novel approaches in development are vaccines that recruit the body’s immune system to prevent opioids from entering the brain; these have already shown great promise in animal studies.
Third, we need safe, effective, non-addictive treatments to manage chronic pain. While there were nearly 20,000 overdoses in 2015 due to heroin or fentanyl, the trajectory of opioid addiction usually begins with prescription opioid misuse. Some people with opioid addiction began by taking diverted pills from friends and family members, but others began with an opioid prescription of their own.
But simply reducing medical use (and thus supply) of addictive prescription opioids, as the Centers for Disease Control and Prevention (CDC) and other authorities have recently advised, does not address the very real problem of untreated pain in this country, and we cannot solve the opioid addiction and overdose crisis without better addressing pain at the same time. New pain treatments need to be developed, and the last few years have seen exciting developments in this area.
For example, compounds called biased agonists that produce pain relief via the mu-opioid receptor but without the rewarding and respiratory depressing effects produced by currently approved opioid medications have recently shown promise in animal studies. Non-opioid-based approaches like cannabinoids, sodium channel blockers, gene therapies, and brain-stimulation technologies (such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation, and electrical deep brain stimulation) also may lead to new therapeutics.
This initiative will focus on a range of objectives—from easily achievable short-term goals (such as reformulations of existing medications) to research priorities that will take longer to bear fruit. But as announced at the Rx Summit last month, across the board, NIH will be partnering with pharmaceutical industry leaders to cut in half the time it takes to develop new treatments. Public-private partnerships are already a part of the NIH’s “Cancer Moonshot” and other initiatives, and some of the current medications saving lives—such as Probuphine® and Nasal Narcan®—and rescuing opioid users from the grip of addiction were developed through NIDA partnerships with industry.
Extraordinary focus is being brought to the opioid crisis by all segments of our society, so now is the time to leverage this awareness to accelerate the pace of research to develop new treatments. From the standpoint of NIH and NIDA, it is “all scientific hands on deck.” NIH research can help end the crisis, and we are committed to doing so.
Reference:
[1] The role of science in addressing in opioid crisis, Volkow ND, Collins FS. May 31, 2017. [Epub ahead of print]
Links:
Opioid Crisis (National Institute on Drug Abuse/NIH)
National Rx Drug Abuse and Heroin Summit
Addressing America’s Fentanyl Crisis (NIDA)
Medications to Treat Opioid Addiction (NIDA)
Preventing Drug Abuse: The Best Strategy (NIDA)
Note: Nora Volkow, M.D. is Director of the National Institute on Drug Abuse (NIDA), NIH; Francis Collins, M.D., Ph.D., is the Director of the National Institutes of Health (NIH).
As far as opiate addiction, in my opinion there is an aspect that is not given its due emphasis, as far as in-depth research,which is why morphine is produced naturally in frogs and man (physiologically at ultra-low concentrations), and are the other two main opium alkaloids biosynthetic branches i.e. benzylisoquinoline and phthalideisoquinoline equally operational at ultra low concentration levels in our body? If so, could this possibly explain opiate addiction, when the body is overwhelmed with extraneous morphine, and as a result the normal physiological pathways get repressed ? Answers to these fundamental questions will raise a whole range of other ones as to the significance of these so called ‘secondary metabolic’ pathways as far as cellular differentiation, morphogenesis and the immune response in animals including man, and how does this interrelate to the roles played by endorphins and enkephalins, and may even lead to fundamental cures not only for addiction, but possibly cancers and other disease conditions ….I believe it is high time to start thinking outside the ‘conventional box’, if we are to start talking about fundamental cures.
Please give the patient a daily multivitamin with minerals complete with rare earth minerals as this group tends to have a mineral & vitamin deficiency. Also, consider prescribing olive oil as a pain killers because it’s very effective. When patients are in chronic pain consider the possibility of long term malnutrition as this is a very painful process. It can’t hurt to increase vegetables and consider the possibility of an electrolyte deficiency or long-term muscle wasting due to malnutrition.
right now opioid-related death is increasing like a fire. people are dying due to this painkiller. there is an increase of more than 20 percent in opioid-related deaths between 2014 and 2015 in the USA only. and we don’t even have stats of 2015-2016 and 2016-2017.
And if strict laws are applied against it then it will affect Medical in USA.
So the government should do regarding it before this death toll increase more.
This is all due to the PAIN DECADE 2000-2010–not to tell the world is outrageous. The law cannot regulate medical care.
Why do folks still insist on opioids or rather Rx pain meds are the cause of all the overdoses and death that illicit fentanyl, heroin, polysubstance and alcohol are the true and actual causes of the majority! Do your homework people! Even CDC admitted their error in lumping medically used Rx drug deaths and illicit abused multidrug overdose and death!
>”simply reducing medical use (and thus supply) of addictive prescription opioids, as the Centers for Disease Control and Prevention (CDC) and other authorities have recently advised, does not address the very real problem of untreated pain in this country, and we cannot solve the opioid addiction and overdose crisis without better addressing pain at the same time” –The very real problem is “Untreated pain”? UNDERtreated pain not also a very real problem? As though we should pretend no problem so long as SOME pain treatment–however far from adequate? The WHO has its cancer pain ladder advocating use of opioids as necessary when cancer patients’ require opioids for optimal analgesia. Why would anyone imagine differently w/ the rest of us?
Most welcome to read:
>”we cannot solve the opioid addiction and overdose crisis without better addressing pain at the same time. New pain treatments need to be developed, and the last few years have seen exciting developments in this area.
For example, compounds called biased agonists … have recently shown PROMISE IN ANIMAL STUDIES.” Non-opioid-based approaches … also MAY lead to new therapeutics.” (my emphasis). Well these “exciting developments” sound at best YEARS away from being developed, amply investigated, available. By your own statement we cannot solve the “addiction and overdose crisis” “without better addressing pain at the same time.” So how can we be in a position to soundly, responsibly, humanely restrict opioid prescription for several more years at best? “[A]t the same time whichever of these purportedly “exciting developments” finally bear fruit.
Finally, why isn’t addiction considered a crisis with cancer patients? How do we know, for starters, how many of the diverted prescription opioids are diverted from someone other than them? Second, if the presumption is terminal cancer patients will never be better off without opioids, why presume that’s not so with however many other patients? What does it matter how “addicted” us Hashimoto’s patients are to supplemental thyroid hormone insofar as no foreseeable point when we would not medically need this drug? The WAO doesn’t restrict its cancer pain ladder to terminal patients regardless: does it? Nor am I aware of anything inherently different about pain with various cancers.