The role of science in addressing the opioid crisis.

12/22/2017

Volkow ND, Collins FS. (2017). The role of science in addressing the opioid crisis. The New England Journal of Medicine. 377(4): 391-394. doi: 10.1056/NEJMsr1706626

In response to the opioid crisis in the United States, the National Institutes of Health (NIH) plans to work with private partners in an initiative to develop (1) better overdose reversal and prevention interventions, (2) new treatments for opioid addiction, and (3) different interventions for managing chronic pain. This paper describes short-, intermediate-, and long-term research strategies for all three goals. Future research for overdose reversal and prevention will investigate stronger methods of overdose reversal for synthetic opioids (e.g. fentanyl), alternative overdose reversal interventions (e.g. alternative agonists, nerve-stimulation devices), and methods of predicting overdose (e.g. using wearable devices). Future research on opioid addiction treatment will investigate an implant for long-term administration of buprenorphine, medication for altering reward pathways involved in opioid use, and vaccines that introduce antibodies to opioids into the blood to prevent opioids from reaching the brain. Finally, future research in alternative methods of pain management will investigate altering opioids to be more difficult to abuse, non-addictive opioids, methods of pain management not involving opioids (e.g. cannabinoids), non-pharmacologic methods of pain management (e.g. repetitive transcranial magnetic stimulation), and biomarkers for pain and pain relief. The NIH hopes that partnering with private partners for this three-pronged initiative, in what they call an “all hands on deck approach”, will reduce the time needed to develop safe and effective approaches to prevention and treatment of opioid addiction and overdose.