New Funding Opportunities in Response to the Opioid Crisis

From the blog of Dr. Nora Volkow
Executive Director, National Institute on Drug Abuse
December 10, 2018

Today, NIDA is releasing several new funding opportunity announcements related to the NIH HEAL (Helping to End Addiction Long-term) Initiative. Researchers now can submit proposals for major projects funded through NIH HEAL in the areas of preventing opioid use disorder (OUD), improving OUD care in justice settings, determining the appropriate duration of treatment with medications to treat OUD, and better understanding how to manage mild or moderate OUD.

Prevention

Older adolescents and young adults (ages 16-30) are the group at highest risk for opioid initiation, misuse, OUD, and death from overdose, so targeting this age group for prevention interventions could have a sizeable impact on reducing the toll of opioid misuse and addiction. The research project called Preventing At-Risk Adolescents from Developing Opioid Use Disorder as they Transition into Adulthood will develop and test strategies to prevent initiation of opioid misuse and development of OUD in different healthcare settings (including primary care, emergency departments, urgent care, HIV/STI clinics, and school or college health clinics) as well as workplaces and justice settings. NIDA will fund a suite of integrated studies developing, testing, and validating screening and prevention tools in areas most affected by the opioid crisis or with indicators of an emerging crisis. For more information on funding opportunities related to this project, see the funding opportunity announcements for the Coordinating Center and research studies.

Criminal Justice System

Substantial research over the past several years has highlighted the consequences of untreated OUD in justice-involved populations—for instance, the high rates of overdose death among people recently released from prison—as well as showing the benefits of treating opioid-addicted prisoners using medication. It remains unknown what specific strategies are most effective at addressing opioid addiction in this population and reducing adverse outcomes. As part of the HEAL Initiative, NIDA will fund the creation of a network of researchers who can rapidly conduct studies aimed at exploring the effectiveness and adoption of medications, interventions, and technologies in justice settings.

The Justice Community Opioid Innovation Network will implement a survey of addiction treatment delivery services in local and state justice systems around the country and will develop new research methods to ensure that treatment interventions have the maximum impact.  For more information, please see the funding opportunity announcements for the Coordination and Translation Center, Methodology and Advanced Analytics Resource Center, and the research centers. 

Other Initiatives

In addition to the above referenced projects, NIDA will be partnering with other NIH institutes and centers on several opioid-related research projects. HEAL funds will also be used to answer some important research questions to address the opioid crisis. For example, NIDA’s Clinical Trials Network (CTN) will be utilized to determine the optimal length of medication treatment for opioid addiction and to identify treatment strategies to manage patients who present to primary or integrated care settings with low-level opioid misuse or OUD. Finally, HEAL funds are being considered to support a longitudinal study to understand the consequences of pre- and postnatal opioid and other substance exposure on the developing brain and behavior.

A silver lining of the dark cloud of the opioid crisis is that it has galvanized communities, healthcare systems, and government agencies to take significant steps toward ending opioid misuse and addiction in a compassionate, science-based way. The funds granted by Congress as part of the NIH HEAL. Initiative will accelerate scientific solutions to the crisis and generate new knowledge that will prevent future drug crises, as well as inform many other areas of medicine and public health. Information related to these projects is available on the NIH site.

Find Help Near You

The following website can help you find substance abuse or other mental health services in your area: www.samhsa.gov/Treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org

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Supporting Our Physicians in Addressing the Opioid Crisis

From the blog of Dr. Lora Volkow dated August 31, 2018

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A recurring theme among addiction researchers and professionals is the so-called treatment gap: under-utilization of effective treatments that could make a serious dent in the opioid crisis and overdose epidemic. Ample evidence shows that when used according to guidelines, the agonist medications methadone and buprenorphine reduce overdose deaths, prevent the spread of diseases like HIV, and enable people to take back their lives. Evidence supporting the effectiveness of extended-release naltrexone is also growing; but whereas naltrexone, an opioid antagonist, can be prescribed by any provider, there are restrictions on who can prescribe methadone and buprenorphine.

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A series of editorials in the July 5, 2018 issue of the New England Journal of Medicine made a strong case for lessening these restrictions on opioid agonists and thereby widening access to treatment with these medications. For historical reasons, methadone can only be obtained in licensed opioid treatment programs, but experimental U.S. programs delivering it through primary care docs have been quite successful, as have other countries’ experiences doing the same thing. Although buprenorphine can be prescribed by primary care physicians, they must first take 8 hours of training and obtain a DEA waiver, and are then only allowed to treat a limited number of patients. Some physicians argue that these restrictions are out of proportion to the real risks of buprenorphine and should be lessened so more people can benefit from this medication.

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Stigma contributes to reluctance to use evidence-supported treatment—both stigma against addicted individuals and stigma against agonist medications, due to the persistent myth that they just substitute a new addiction for an old. This idea reflects a poor understanding of dependence and addiction. Dependence is the body’s normal adaptive response to long-term exposure to a drug. Although people on maintenance treatment are dependent on their medication, so are patients with other chronic illnesses being managed medically, from diabetes to depression to pain to asthma. Addiction, in contrast, involves additional brain changes contributing to the loss of control that causes people to lose their most valued relationships and accomplishments. Opioid-dependent individuals do not get high on therapeutic doses of methadone or buprenorphine, but they are able to function without experiencing debilitating withdrawal symptoms and cravings while the imbalances in their brain circuits gradually normalize.

Treating patients with addiction may be uniquely complex and demanding for several reasons. Patients may have co-morbid medical conditions, including mental illness; thus they may need more time than doctors are reimbursed for by insurers. They may also have pain, and while pain management guidelines have changed to respond to the opioid crisis, those changes have not necessarily made a doctor’s job any easier, since there are currently no alternative medications to treat severe pain that are devoid of dangerous side effects.

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Because of the complexity of Opioid Use Disorder (OUD), providers may find that it is not sufficient to simply dispense a new prescription after a quick consultation. These patients often need ancillary services provided by nurses or other treatment specialists; and in the absence of these extra layers of support, treatment is less likely to be successful, reinforcing physicians’ reluctance to treat these patients at all. In short, physicians are being blamed for causing the opioid epidemic, but thus far they have not been aided in becoming part of the solution.

Medical schools are starting to respond to the opioid crisis by increasing their training in both addiction and pain. For example, as part of its training in adolescent medicine, the University of Massachusetts Medical School has begun providing pediatric residents with the 8-hour training required to obtain a buprenorphine waiver—an idea that is winning increasingly wide support. Physicians in some emergency departments are also initiating overdose survivors on buprenorphine instead of just referring them to treatment. And through its NIDA MedPortal, NIDA provides access to science-based information and resources on OUD and pain to enable physicians to better address these conditions and their interactions, including easy-to-use screening tools to help physicians identify substance misuse or those at risk.

But if physicians are going to assume a bigger role in solving the opioid crisis, healthcare systems must also support them in delivering the kind of care and attention that patients need. Physicians need the tools to treat addiction effectively as well as the added resources (and time) for patients who need more than just a quick consultation and a prescription.

The Opioid Issue: Part 5

Part Five: Troubling Vital Signs

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The opioid epidemic is straining America’s health care and treatment resources, while opening the door for unscrupulous fraudsters to make money off those struggling to overcome addiction. How much more can emergency rooms handle? The most recent numbers from the U.S. Centers for Disease Control and Prevention (CDC), spanning 45 states, show nearly 143,000 ER visits for opioid overdoses over a 15-month period. That period ended in the third quarter of 2017 and represented a 30-percent jump from the same time span a year earlier.

“The staff isn’t sure what to do with [opioid overdose patients],” says Karl Benzio, M.D., a Christian psychiatrist and member of Focus on the Family’s Physicians Resource Council (PRC). “You don’t feel comfortable just discharging the person. The staff doesn’t know how dangerous the person is when they leave the doors, whether they will overdose—or worse—when they leave, how to find a responsible party to transfer the care and responsibility to.” Fellow PRC member W. David, Hager, M.D., agrees. “We’re seeing a lot of frustration among our providers with ‘frequent fliers,” says Hager, a practicing physician with Baptist Health Medical Group in Lexington, Kentucky. Both physicians point to different problems connected to the opioid crisis.

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Benzio notes that many overdose cases are complicated because ER staffs aren’t generally equipped to deal with mental or behavioral health. Many of those patients  should ideally be in a residential rehabilitation program, but are unable to secure health care insurance coverage. This leaves the medical personnel on the front lines of care facing a dilemma for which there are no simple answers. Between the rapid rise in overdose cases and the moral gray area of providing narcotics to so-called “frequent fliers,” America’s emergency rooms are in a precarious position when it comes to the opioid issue. The crisis threatens to break the backs of overworked ER staffs, whose efforts to help those in pain with long-term prescriptions may only be fueling the crisis.

FAKE TREATMENT CENTERS

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The overwhelming strain the opioid epidemic has placed on legitimate health care providers has also opened the doors for unscrupulous con artists looking for easy money. These fraudsters—and it’s not clear just how many there are across the country—run fake treatment centers preying on those seeking a way out of their opioid struggles.

“Several factors came together—so many people in need of addiction treatment and managed care to reduce their length of stay in the hospital—that there became a huge need for more addiction rehabs,” Benzio explains. “Certain states that had a high level of drug use made it very easy to open a rehab; not many restrictions, licensing issues or hoops to go through. Also, insurance plans needed a place to put someone who was in danger of overdosing but needed one-on-one monitoring, so entities put together minimally-trained people with a schedule and sold it to the insurance as a rehab.” With the potential to make big money and only vague criteria for what a “quality” treatment facility includes, many unqualified providers jumped into the rehab industry.

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“A lot of people going through addiction thought, ‘Wow, I could put together a better program than that,’ so they developed their own after getting clean for 20 minutes,” says Benzio. Though he believes some who entered the rehab industry in this way truly wanted to help, others are outright shams and just billing insurance large sums. Some bill for services they don’t even provide. Some will encourage their patients to use drugs or supply them so they can continue to bill insurance. Many cannot get doctors or licensed therapists [on staff], which would make them accountable to higher state and national licensing standards.

UNSCRUPULOUS REHAB CENTER OPERATORS

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Somehow, even with all our laws pertaining to drug possession and use, we still find ourselves in a largely unregulated addiction treatment field. And even worse, the biggest driving force seems to be well-meaning legislation—like the Affordable Care and Parity Acts—which made treatment more accessible for more people, but unfortunately also opened the door for predators and frauds to get in on the action. They are unconscionably attempting to make a profit off our nation’s current drug epidemic with unethical and shocking practices like patient brokering, identity theft, kickbacks, and insurance fraud.

A behavioral healthcare survey on ethical concerns in the drug rehab industry identified patient brokering tactics in the form of money and gifts that some treatment centers are using to entice patients. Need sober living but can’t afford it? Some programs address this by offering free room and board and other amenities, then bill insurance excessively for unnecessary drug testing and other services to make up the cost. Sadly, many unregulated sober living homes have become unsafe and overcrowded “flophouses” where crimes like theft, human trafficking, prostitution, and illegal drug use are commonplace.

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We’re also seeing patients-turned-recruiters, people just out of treatment with very little time in recovery who can suddenly start making big money selling people they know to rehab centers, checking themselves into competitor programs to lure clients away, and collecting “finder’s fees” of $500 to $1,000 per patient or more. And if that doesn’t work, people are getting paid to relapse so that treatment centers can collect more insurance money. Shockingly, some of these practices are not per se illegal. And in situations where they are, states do not have the resources to regulate.

A Palm Beach Post investigation of the county’s $1 billion drug treatment industry found that testing the urine of recovering addicts is so lucrative that treatment centers are paying sober living homes for patients. Urine drug screen costs may be $6 once a week, but centers test every 48 hours and bill insurance companies $1,200 each time. You may have heard about treatment center owner Kenneth Chatman. A federal investigation targeted sober living homes and rehab centers founded by Chatman and others. Chatman appeared before a U.S. magistrate in West Palm Beach, Florida. The recovery businesses founded by Chatman provided illegal kickbacks, coerced residents into prostitution, threatened violence against patients, and submitted urine and saliva for screening even when no medical need existed.

It’s an exploitation of some of our nation’s most vulnerable individuals and it needs to stop!

FINDING REAL HELP

Amid a sea of get-rich-quick frauds, how can those struggling to overcome opioid addiction find genuine help? How can they—and their families—be sure they’re not scammed by fraudsters? Benzio says quality facilities have several standout features. He advises looking for those that are Christian-owned, apply the Bible to daily living, and emphasize the importance of growing in a relationship with God. Some of the other key elements include:

  • One of the owners is an accomplished clinician, such as a psychiatrist, counselor, or therapist. Clinicians with ownership stakes usually have professional reputations to maintain, an understanding of what great care looks like, and a desire to make clinical excellence a primary focus.
  • A psychiatrist sees the patient early in the admission process for detox purposes and to help diagnose underlying issues that contribute to the patient’s opioid use.
  • The treatment and residential facilities are located on the same campus, allowing for a higher level of accreditation and insurance approval.
  • Individual therapy is provided by masters-level and/or licensed therapists. Each patient receives several individual sessions per week.

A FAMILY AFFAIR

Between the overloaded hospitals, risky prescribing practices and minefield of rehab programs, the opioid epidemic is stretching and straining America’s health care resources like nothing we’ve ever seen. Tackling those (and many other) massive opioid-related issues will require innovative solutions.

Cece and Bobby Brown of Charleston, WV had a son who died four years ago at age 27. His parents describe him as being “just like the kid next door,” stating he was a trouble-free child who loved sports, music, skateboarding, and God. His mother said, “I sent him to college to get a degree, and he came home with an addiction.” Ryan struggled with opioids for seven years, surviving three overdoses along the way. But in April 2014, he had another—at the local mall. The Browns believe their son ran into an acquaintance there who gave him the heroin that snuffed out his life.

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The couple spent thousands on detox and rehabilitation programs for Ryan. What he really needed, they say, was a long-term facility where he could get clean for good. Instead, a typical cycle for Ryan would consist of seven days of detox and regular participation in outpatient programs, therapy groups and Narcotics Anonymous. That combination would keep him clean for about six weeks.

But he needed more.

Ryan was on waiting lists for two long-term treatment centers when he died. Having aged out of his parents’ insurance plan at 26, he had just received Medicaid benefits three days before his death. Most heartbreaking, his parents learned after his passing that a treatment facility that could have accepted Ryan was only three miles away. Now his parents can’t help but wonder, What if the wait times had been shorter, the coverage had come a bit earlier, and we had known about the facility nearby?

“That would’ve given opportunity. I can’t say that would have changed things, but opportunity is everything,” Cece says. Over the last four years, the Browns have made it their mission to make sure others with similar struggles in West Virginia have the opportunities Ryan didn’t.

INNOVATE FOR THE STATE

After a two-year effort led by Bobby and Cece, last year West Virginia lawmakers passed legislation creating the Ryan Brown Addiction Prevention and Recovery Fund. The Fund aims to expand the state’s capacity to help those struggling with opioids but lacking private insurance, Medicaid or Medicare coverage by blending public grants and private dollars. People can contribute charitable gifts.

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So far, the model has yielded promising results: The West Virginia Department of Health and Human Services has awarded $20.8 million through the Fund to nine long-term treatment facilities statewide. That’s already translated to 300 more West Virginians getting treatment than would’ve been the case otherwise. The Browns explain it’s just reality that many struggling with opioids have low-wage jobs that don’t offer insurance. Some, they say, have felonies that prevent them from securing jobs with better wages and benefits. But that doesn’t mean they should be left behind. Bobby said, “If they don’t want help, there’s nothing we can do. But if they do want help, we need to get them help.”

The Browns are also grateful West Virginia has addressed another problem: In September 2015, the state launched a resource hotline to help those combating opioid addiction.  “We didn’t have a number to call to talk to anyone; didn’t know where to get help,” Bobby recalls. “Now that number has come out.” Those needing help can simply call 1-800-HELP-4WV—and thousands have.

Bobby and Cece say they feel honored to play a role in easing the burden the opioid epidemic has placed on the health care system, and to help families struggling with the weight of it all find solid answers. They’ve been part of several White House events aimed at finding solutions, and say they’ll continue to engage the Trump administration in the hopes of keeping the heat on. As a reminder of the epidemic’s devastating toll, Cece displayed a picture of Ryan at a round table discussion with First Lady Melania Trump earlier this year.

This needs to be about people, not politics.

Addressing the Opioid Crisis Means Confronting Socioeconomic Disparities

FROM THE BLOG OF DR. NORA VOLKOW, EXECUTIVE DIRECTOR
NATIONAL INSTITUTE ON DRUG ABUSE

October 25, 2017

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The brain adapts and responds to the environments and conditions in which a person lives. When we speak of addiction as a chronic disorder of the brain, it thus includes an understanding that some individuals are more susceptible to drug use and addiction than others, not only because of genetic factors but also because of stress and a host of other environmental and social factors in their lives that have made them more vulnerable.

Opioid addiction is often described as an “equal opportunity” problem that can afflict people from all races and walks of life, but while true enough, this obscures the fact that the opioid crisis has particularly affected some of the poorest regions of the country, such as Appalachia, and that people living in poverty are especially at risk for addiction and its consequences like overdose or spread of HIV. The Centers for Disease Control (CDC) considers people on Medicaid and other people with low-income to be at high risk for prescription drug overdose.

Below is a pic of teens in Allegheny County, Pennsylvania, the heart of Appalachia.

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Some of the reasons have to do with access and quality of health care received by people in economically disadvantaged regions. According to the U.S. Department of Health and Human Services, people on Medicaid are more likely to be prescribed opioids, at higher doses, and for longer durations – increasing their risk for addiction and its associated consequences. They are also less likely to have access to evidence-based addiction treatment. But psychological factors also play a role. Last year, economists Anne Case and Agnus Deaton attributed much of the increased mortality among middle-aged white Americans to direct and indirect health effects of substance use, especially among those with less education, who have faced increasing economic challenges and increased psychological stress as a result.

Environmental and social stressors are an important predictor of many mental disorders, and decades of research using animal models have told us a great deal about how such stressors increase risk for substance use, and even make the brain more prone to addiction. Among the best-known animal models of environmental stress and addiction risk are those involving social exclusion and isolation: Solitary animals show greater opioid self-administration than animals housed together, for example – a finding originally made famous by the “Rat Park” experiment of Bruce K. Alexander in the 1970s and replicated by other researchers over the subsequent decades.

Even more pertinent to the question of how low social status might affect addiction risk is research by Michael Nader, who showed that male monkeys who are dominant in their social group demonstrate less cocaine self-administration than lower-ranked (subordinate) animals or solitary ones. Some evidence points to brain circuitry in the insula – a region important in processing social emotions – that may link feelings of social exclusion to increased drug craving, as well as possibly altered dopamine-receptor availability in the striatum – part of the reward circuit – depending on social status. The relationship may be bi-directional. In other words, exclusion not only increases risk for using drugs, but increased drug use can increase social isolation further, creating a vicious cycle. Similarly, when people have strong family or community relationships, this often acts as a protective factor against the risk of becoming addicted, and can facilitate recovery among those striving to achieve it.

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Another animal model of environmental stress is an environment without opportunities for play, exploration, and exercise. Rodents housed in non-enriched environments have been shown to be more sensitive to the rewarding effects of heroin compared to those in more enriched environments. A team of researchers at the University of Texas Medical Branch in Galveston recently explored the molecular mechanisms that mediate the protective effects of enriched environments. They analyzed the transcriptome – or the parts of the genome that are expressed – in the nucleus accumbens, which is part of the reward circuit, following cocaine exposure in animals raised in either enriched or dull environments. They identified a number of molecules and signaling pathways, including a pathway involving retinoic acid – a product of Vitamin A metabolism – that may underlie the effects of an enriched environment on the brain’s processing of reward. The researchers suggest that the mild stressors and surmountable challenges presented by an enriched environment act to “inoculate” against stress, making individuals in those environments more resilient.

Although highly simplified, animal models of social and environmental stress can tell us a great deal about how stressful human environments may act as risk factors for substance use and other adverse outcomes and, conversely, how socially supportive and rewarding environments may offer protection. Prevention efforts targeting some of the environmental determinants of substance use, especially in young people, have already shown great success by applying the principles of boosting social support and creating the human equivalent of “enriched environments.” For example, a primary prevention model implemented in Iceland drastically reduced teen substance use in that country by increasing parental involvement and youth participation in team sports.  

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Blame for the opioid crisis now claiming 91 lives every day is often placed on the supply side: overprescription of opioid pain relievers and the influx of cheap, high-quality heroin and powerful synthetics like fentanyl, which undoubtedly have played a major role. But we cannot hope to abate the evolving crisis without also addressing the lost hope and opportunities that have intensified the demand for drugs among those who have faced loss of jobs and homes due to economic downturns. Reversing the opioid crisis and preventing future drug crises of this scope will require addressing the economic disparities, housing instability, poor education quality, and lack of access to quality health care (including evidence-based treatment) that currently plague many of America’s disadvantaged individuals, families, and communities.

References

Volkow, N. (October 25, 2017). “Addressing the Opioid Crisis Means Confronting Socioeconomic Disparities.” [Web blog comment.] Retrieved from:  https://www.drugabuse.gov/about-nida/noras-blog

 

The Role of Science in Addiction

SPECIAL REPORT
From the New England Journal of Medicine
May 31, 2017
By Nora D. Volkow, M.D, and Francis S. Collins, M.D., Ph.D.

Opioid misuse and addiction is an ongoing and rapidly evolving public health crisis, requiring innovative scientific solutions. In response, and because no existing medication is ideal for every patient, the National Institutes of Health (NIH) is joining with private partners to launch an initiative in three scientific areas:

  1. developing better overdose-reversal and prevention interventions to reduce mortality, saving lives for future treatment and recovery;
  2. finding new, innovative medications and technologies to treat opioid addiction; and
  3. finding safe, effective non-addictive interventions to manage chronic pain.

Overdose-Reversal Interventions

Every day more than 90 Americans die from opioid overdoses. Death results from the opioid’s antagonistic effect on brainstem neurons that control breathing. In other words, the victim succumbs to respiratory failure. Naloxone can be used effectively to reduce the effect of opioid intoxication, thereby reversing the overdose, if it is administered in time. Although naloxone has saved tens of thousands of lives, overdoses frequently occur when no one else is around, and often no one arrives quickly enough to administer it.

Overdose fatalities have also been fueled by the increased availability of very powerful synthetic opioids such as fentanyl and carfentanil (50-100 times and 5,000-10,000 times more potent than heroin respectively). Misuse or accidental exposure to these drugs (e.g., when laced in heroin) is associated with very high overdose risk, and naloxone doses that can often reverse prescription-opioid or heroin overdoses may be ineffective. New and improved approaches are needed to prevent, detect and reverse overdoses.

Treatments for Opioid Addiction

The partnership will also focus on opioid addiction (the most serious form of opioid use disorder), which is a chronic, relapsing illness. Abundant research has shown that sustained treatment over years or even a lifetime is often necessary to achieve and maintain long-term recovery. Currently, there are only three medications approved for treatment: methadone, buprenorphine, and extended-release naltrexone. These medications, coupled with psychosocial support [such as rehab and 12-step programs] are the current standard of care for reducing illicit opioid use, relapse risk, and overdoses, while improving social function. There is a clear need to develop new treatment strategies for opioid use disorders. New pharmacologic approaches aim to modulate activity of the reward circuitry of the brain.

Non-Addictive Treatment for Chronic Pain

The third area of focus is chronic pain treatment: over-prescription of opioid medications reflects in part the limited number of alternative medications for chronic pain. Thus, we cannot hope to prevent opioid misuse and overdose without addressing the treatment needs of people with moderate-to-severe chronic pain. Though more cautious opioid prescribing is an important first step, there is a clear need for safer, more effective treatments.

Foremost is the plan to develop formulations of opioid pain medication with built-in abuse deterrent properties that are more difficult to manipulate for snorting or injecting, the routes of administration most frequently associated with misuse because of their more immediate rewarding effects. Such formulations, however, can still be misused orally and still lead to addiction. Thus, a more promising long-term avenue to addressing pain treatment will involve developing a powerful non-addictive analgesic. There are some fascinating x-ray crystallography studies going on that look promising.

Non-pharmacologic approaches being explored today, including brain-stimulation technologies such as high-frequency repetitive transcranial magnetic stimulation (rTMS, already FDA-approved for depression), have shown efficacy in multiple chronic pain conditions. At a more preliminary stage are viral-based gene therapies and transplantation of progenitor cells to treat pain. NIH researchers are investigating the use of gene therapy to deliver a potent anti-inflammatory protein directly to painful sites. Pre-clinical studies show powerful and long-lasting effects in reducing pain without side effects such as numbness, sedation, addiction, or tolerance.

Public-Private Partnerships

In April 2017, the NIH began discussions with pharmaceutical companies to accelerate progress on identifying and developing new treatments that can end the opioid crisis. Some advances may occur rapidly, such as improved formulations of existing medications, opioids with abuse-deterrent properties, longer-acting overdose-reversal drugs, and repurposing of treatments approved for other conditions. Others may take longer, such as opioid vaccines, and novel overdose-reversal medications. For all three areas, the goal is to cut in half the time typically required to develop new safe and effective therapeutics.

As noted throughout the history of medicine, science is one of the strongest allies in resolving public health crises. Ending the opioid epidemic will not be any different. In the past few decades, we have made remarkable strides in our understanding of the biologic mechanisms that underlie pain and addiction. But intensified and better-coordinated research is needed to accelerate the development of medications and technologies to prevent and treat these disorders. The scope of the tragedy of addiction and overdose deaths plaguing our country is daunting. The partnership between NIH and others will take an all hands on deck approach to developing and delivering the scientific tools that will help end the opiate epidemic in America and prevent it from reemerging in the future.

References

Volkow, N. and Collins, F. (May 31, 2017). “The Role of Science in Addressing the Opioid Crisis.” The New England Journal of Medicine. DOI: 10.1056/NEJMsr1706626

Volkow, L. (May 31, 2017). “All Scientific Hands On Deck to End the Opioid Crisis.” [Web blog comment]. Retrieved from : https://www.drugabuse.gov/about-nida/noras-blog/2017/05/all-scientific-hands-deck-to-end-opioid-crisis