Nora Volkow, M.D., Outlines NIDA’s Marijuana, Opioid Research Goals
Abstract
Among the focus areas Volkow highlighted are studies on the neurodevelopmental effects of adolescent marijuana exposure and the long-term effects of opioid overdose.
The start of APA’s 2018 Annual Meeting coincided with the 15th anniversary of the appointment of Nora Volkow, M.D., as director of the National Institute on Drug Abuse (NIDA). To celebrate, Volkow presented a forward-looking lecture that explored some of today’s pressing issues in drug use and addiction and how NIDA aims to address those problems.
New research suggests that a sodium channel blocker combined with a tiny amount of buprenorphine can produce a strong analgesic effect, Nora Volkow, M.D., tells Annual Meeting attendees.
Her lecture focused on two substances in particular: marijuana and opioids. While these drugs receive a lot of attention, Volkow noted that the leading causes of death in the United States are alcohol and tobacco. “It’s not because these substances are more dangerous than opioids,” she said. “It’s because they are legal.”
Volkow explained that NIDA is paying close attention to the impact of legalized marijuana in many states across the country and what it means for the health of Americans. The states that have legalized marijuana have approached regulations differently, which offers a good opportunity for researchers to see how different policies affect health outcomes, she noted.
How the increased marijuana availability will affect adolescents will be particularly important to study. Volkow cited national data indicating that while the rates of substance use among teens have dropped for virtually every substance over the past few years, the rates of marijuana use have remained stable.
Marijuana is primarily inhaled, and smoking-related diseases take a long time to develop, but teen smoking is a unique consideration. “Adolescents are taking marijuana in a period in their life when they are learning greatly. Being exposed to marijuana may disrupt their ability to learn and lead to long-lasting pharmacological effects.”
The Adolescent Brain Development Study (ABCD)—which plans to follow about 10,000 children from ages 9 to 21—will be valuable in addressing that question, Volkow continued. She added that as of May, ABCD had enrolled over 9,100 participants, so researchers are well on their way to surpassing their enrollment goal. “For the first time, we will have a database that will help us understand what is considered normal adolescent brain development.”
While the availability of legal marijuana is rising, the number of opioid prescriptions is falling, Volkow said, though prescribing rates are still high overall. “The problem now is that we have more people using illicit substances like heroin and synthetic opioids, and overdoses are rising.”
The increased use of naloxone is helping prevent some overdose deaths, though that leads to another research question for NIDA: What are the long-term consequences of overdose, and how do opioid combinations such as heroin and fentanyl affect the biology of hypoxia that follows an overdose?
NIDA is heavily invested in finding new medications for pain that are effective but not addictive, Volkow noted. Targets being explored include mu-opioid receptors and sodium channel blockers. Sodium channel blockers have been studied before and found to be not that effective on their own, but Volkow said that new preclinical research findings suggest that combining a sodium channel blocker with just a tiny amount of buprenorphine can produce a strong analgesic effect.
Not all opioid addiction can be prevented, though, she said, and NIDA is continuing to research better models of addiction therapy, especially nonpharmacological ones. Some examples include neurostimulation, both electrical and magnetic, and the development of antibodies that bind to drug molecules in the blood—essentially a vaccine to prevent addiction.
Even as NIDA continues to support studies to improve treatments for opioid use disorder, Volkow noted that patients today can benefit from medication-assisted therapy, including buprenorphine or naltrexone. The big limitation for patients today, she added, is lack of access.
“Psychiatrists need to be more involved in treating addiction,” Volkow concluded. “I hope I can convince you to get your waivers, so you can prescribe buprenorphine and actively screen and treat your patients for substance use disorders,” she said. ■
APA offers a number of training options that allow qualified clinicians to apply for a waiver to their Drug Enforcement Administration license and provide office-based buprenorphine treatment. More information can be accessed here.
