Is a ‘smarter’ opioid on the way?
A study published today in the journal Cell concludes that it’s possible to create pain-relieving opioids that don’t cause side effects. These side effects include anxiety, nausea, and dependency.
As they are, opioids bind to receptors on the cell surface.
A team led by researchers at the University of North Carolina School of Medicine examined how the kappa opioid receptor (KOR), a protein on the cell surface, is activated.
With that knowledge, the researchers say they developed a new drug-like compound that only activates that receptor.
Knowing that structure, Dr. Bryan Roth, a professor at UNC-Chapel Hill, said that drug-like compounds could be developed to be more selective to specific opioid receptors.
By targeting KORs, the few drugs that bind to it don’t lead to addiction or cause death due to overdose, Roth explained.
“Drugs targeting this receptor are likely to have low-addiction potential and to not be associated with respiratory depression, which leads to death in opioid overdoses,” Roth told Healthline.
In addition, Amber C. Lindsey, LCDC-I, a program director at Taylor Recovery Center in Houston, told Healthline that vaccines are currently being developed to target opioids in the bloodstream in hopes of preventing the drug from reaching the brain and exerting euphoric effects.
Additionally, work is being done to explore the potential use of transcranial direct current stimulation, a noninvasive brain stimulation technique for treating opioid use disorder.
Treating addiction with other drugs
While 12-step programs can work effectively to treat alcohol use disorder, that’s not the case for people addicted to opioids.
Remedying opioid addiction with medication-assisted treatment is the most promising avenue, says Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University in Massachusetts.
First, he notes, the country must prevent people from becoming addicted. That requires being more cautious in prescribing opioids.
“Prescribing practices have to change,” Kolodny told Healthline.
Second, it may be necessary to treat people who are already addicted with other drugs.
The country as a whole, Kolodny said, isn’t making it easy to access these addiction-defeating drugs.
Buprenorphine remains the best treatment for opioid addiction. It’ll soon be available as a monthly injection so people don’t have to remember to take a pill daily.
However, Kolodny noted that although doctors can prescribe opioids, they’re more regulated when prescribing the treatment for opioid addiction.
Physicians must complete an eight-hour training to apply for permission to prescribe buprenorphine under The Drug Addiction Treatment Act of 2000.
The law grants a Drug Enforcement Agency (DEA) waiver to doctors who complete training to prescribe buprenorphine to treat opioid use disorder. There are limits on the numbers of patients a doctor can treat, though.
Most of the doctors doing this don’t take insurance, so funding the treatment has to come out of pocket.
Another challenge to getting treatment is that many people with an opioid addiction don’t know that buprenorphine is an effective treatment, Kolodny said.
They’ve been tested extensively for effectiveness and safety, said Dr. Edwin A. Salsitz, an addiction medicine specialist at Mount Sinai Beth Israel in New York City.
“Generally the medications are combined with psychosocial treatments to provide the optimal outcomes,” Salsitz told Healthline.
Methadone maintenance is helpful for people who don’t do well with buprenorphine. But people have to visit a clinic daily to receive that treatment.
Suboxone is another viable treatment akin to buprenorphine, Kolodny added.
Another barrier to treatment is giving people geographical access to assistance.
A study in Annals of Family Medicine found that about 60 percent of rural counties in the United States don’t have a doctor that can prescribe buprenorphine.
When people hear about drugs for opioid treatment, they may think of the nasal spray Narcan.
While it’s more readily available, people saved by the Narcan antidote may simply overdose again.
“It’s too downstream an intervention,” Kolodny said. “If you save someone and you don’t treat them, you’re just going to have to treat them with it again.”
The Regulation Route
Kolodny says doctors must be regulated and trained in prescribing opioids.
In addition, restrictions that limit buprenorphine access must be lifted.
Manufacturers must also be regulated, Kolodny added.
“The reason we have this epidemic is because doctors started to prescribe aggressively in response to a deceptive marketing campaign that didn’t talk about addiction,” Kolodny said.
The Pharmaceutical Research and Manufacturers of America (PhRMA), in partnership with the Addiction Policy Forum, recently launched “Priorities to Address Addiction in America,” an initiative to address the opioid crisis.
The plan attempts to pinpoint gaps in existing programs, boost education, and connect people to treatment, among other actions.
The organization is also proposing policies that limit the supply of opioid medications to seven days for acute pain, mandate prescriber training, and eliminate coverage barriers that keep patients from accessing all forms of addiction treatment.
A Multifaceted Approach
Salsitz believes there are several methods that can be employed to ease the opioid crisis.
Among them are wider Narcan distribution, more funding for prevention and treatment, decreasing the importation of fentanyl into the United States, and decreasing societal issues that result in increased vulnerability to opioid addiction.
“There is no silver-bullet solution to the opioid epidemic,” Salsitz said. “A multipronged, multidimensional effort is required. Effective treatment exists. Greater accessibility is required.”
Mark W. Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD), told Healthline that it’ll be some time before Americans break free from opioid addiction.
He noted that the criminal justice system has been slow to provide treatment access — something that is changing slowly.
Nevada is one of more than a dozen states that have regulations in place to limit the number of days for an opioid prescription or limit its strength.
A new program there has installed pre-prescription safeguards for doctors. It also bolsters the requirements to continue a prescription after one month, three months, and a year.