By Nora Volkow (Director, NIDA) and Francis Collins (Director, National Institutes of Health)
In 2015, two 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, GA last month, lawmakers and representatives from healthcare, 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.
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.