Volkow Speaks on NIDA Efforts to Combat Prescription Opioid Crisis

As the misuse of and deaths related to prescription opioid painkillers continue to climb at epidemic levels in this country, the National Institute on Drug Abuse (NIDA) is one of a number of federal health agencies that have implemented efforts to address the public health crisis (see page 1). These efforts, according to NIDA Director Nora Volkow, M.D., include strategies involving the development of alternative pain treatments, increased access to easy-to-use drugs that can reverse the effects of an overdose, and more effective treatment for opioid addiction.

David Hathcox

“The epidemic of prescription opioid use is a problem that has continued to grow over the past two decades,” Volkow told Psychiatric News. “It is a problem that has been created by several factors including the health care system.”

From 1999 to 2010, deaths due to prescription opioid drugs quadrupled, paralleling the increase in their legal sales in this same period, according to the Centers for Disease Control and Prevention. The 2014 National Survey on Drug Abuse and Health reported that approximately 1.9 million Americans met the criteria for prescription opioid use disorder based on their use of prescription painkillers within a given year, and 4.3 million people reported using prescription painkillers nonmedically within the same period.

Volkow said that there are two populations of people who are misusing prescription opioids: those who are initiating use of prescription painkillers to get a high because of an underlying addiction to substances and those who are given the medication for pain and subsequently become addicted.

“NIDA is trying to understand what is driving the epidemic and what interventions can keep the epidemic from further spreading. We are also trying to figure out what can be done to prevent people who are addicted to opioid prescription drugs from overdosing and [possibly] transitioning to heroin addiction,” said Volkow.

With regard to the strategic area of finding alternative treatments for pain management, Volkow said, “Opioids are being overprescribed because there is really poor education on how to manage pain. There is a very high prevalence of people presenting with severe and chronic pain, yet there are very few alternative effective treatments. When you put these two factors together, you can understand how the health care system—starting some 20 years ago—had an overreliance on prescription opioids and assumed that the medications were safe.”

To reduce misuse of opioid prescription painkillers, NIDA is funding research focusing on the development of nonopioid medications for pain management as well as behavioral and psychotherapeutic interventions to better manage pain. In addition, said Volkow, the agency is investigating “transformative types of approaches” involving use of transcranial magnetic stimulation and electroconvulsive shock therapy for modifying the function of certain neural networks that regulate pain.

Drug overdose is another target area of NIDA. According to the Drug Enforcement Agency (DEA), drug overdose is the leading cause of injury or death in the United States, surpassing deaths due to motor vehicle accidents and firearms. More than half of the 46,471 drug-related deaths in 2013 were caused by prescription opioid painkillers and heroin, according to the DEA. Volkow said that making naloxone—an overdose-reversal drug—more accessible to the general public is a top priority at NIDA. The drug, which is an opioid receptor antagonist, was initially administered by injection, but last year the Food and Drug Administration (FDA) approved an intranasal version that allows people with no medical training to administer the drug (Psychiatric News, December 18, 2015). NIDA played a critical role in the development of the intranasal spray, working with Adapt Pharma Inc.

NIDA’s third target area is identifying approaches and treatments that can lead to better outcomes, said Volkow. For example, better patient outcomes have been observed when treatment for opioid addiction is initiated during an emergency department visit for an opioid-related overdose, compared with being referred to an opioid treatment facility by emergency department staff. NIDA is also funding research to develop a treatment that will require less time in an opioid treatment clinic, such as a long-acting version of methadone that is effective for six months.

Volkow told Psychiatric News that NIDA is working on securing funding so that it can make grants to institutions to develop curricula on addiction screening and recognition aimed at clinicians, medical students, and nurses. As of now, she emphasized, basic training in this particular area is lacking. ■