More Dangerous Substances Require More Proactive Efforts, Officials Say

With proven treatment options for opioid overdose and opioid use disorder (OUD) available, Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), told Rx Summit attendees on Tuesday evening that there is a lingering question that frustrates her.

“If we have them,” Volkow said of the treatment modalities, “why are we still seeing such a large number of overdoses?”

Dr Volkow then answered her own query: “Perhaps we aren’t using them as much as we should. We know that is the case.”

Dr Volkow, along with National Institutes of Health (NIH) Director Lawrence Tabak, DDS, PhD, and George Koob, PhD, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), shared a series of research updates and developments in the treatment of substance use disorders in their plenary session.

More than 107,000 drug overdose deaths were reported in the 12 months ending in October 2022, the most recent period for which data from the Centers for Disease Control and Prevention (CDC) is available. While that figure is down slightly from the record 109,179 deaths reported in the calendar year 2021, deaths involving synthetic opioids (mainly fentanyl), cocaine, and other psychostimulants have risen. An estimated 60% to 80% of cocaine and methametamphine-involved deaths have also included the presence of fentanyl, Dr Volkow said.

The NIDA director then explained why fentanyl and its analogues present a higher degree of danger than other illicit substances. Dr Volkow cited several key factors, including:

• Fentanyl penetrates the brain more rapidly than other opioids, creating a smaller window for rescue through the use of naloxone;
• Overdose reversals from fentanyl require higher and multiple naloxone doses; and
• Physical dependence from fentanyl is stronger than for heroin, which makes treatment initiation with medications for OUD more difficult.

In light of the deadly nature of fentanyl, as well as the rising threat of the veterinary sedative xylazine, Dr Volkow said it is imperative to invest in prevention initiatives, particularly those aimed at young people.

“As a country, we do not have a sustainable infrastructure,” Dr Volkow said. “I think it behooves us to realize that we need to pay attention to the opportunity to prevent exposure to drugs so that ultimately, we avoid finding ourselves 10 to 15 years from in another overdose crisis.”

HEAL Initiative, Chronic Pain, Alcohol Misuse

Dr Tabak opened his presentation by focusing on the status of NIH’s HEAL (Helping to End Addiction Long-term) Initiative. As of 2023, HEAL has accounted for the following:

• More than $2.5 billion in federal funding invested in research;
• More than 1000 research projects;
• 42 research programs in 50 states;
• 314 clinical trials in progress;
• More than 100 projects addressing back pain;
• More than 200 projects addressing medications for opioid use disorder; and
• 41 Food and Drug Administration (FDA) applications for investigational new drugs.

Dr Tabak highlighted HEAL clinical trials to improve treatment of neonatal opioid withdrawal and chronic back pain in adults.

Later, Dr Koob delved into how the opioid crisis overlaps with chronic pain, alcohol use disorder, and mental illness. Dr Koob noted how alcohol contributes to more than 140,000 deaths and 1 in 6 opioid overdose deaths per year.

He added that alcohol misuse can contribute to pain—both emotional and physical—and that pain contributes alcohol misuse when individuals use drinking to cope. Chronic pain, alcohol use disorder, and opioid use disorder share overlapping brain mechanisms.

To that end, Dr Koob concluded, addressing alcohol misuse in chronic pain and OUD patients could help improve patient outcomes.

Reference

Tabak L, Volkow N, Koob G. Plenary. Presented at Rx and Illicit Drug Summit; April 10-13, 2023; Atlanta, Georgia.