Responding to the Opioid Problem: New Directions in Research by Jack B. Stein, MSW, PhD

Jack B. Stein, MSW, PhDNational Institute on Drug Abuse

Opioid Overdose SummitAnn Arbor, MI

December 1, 2015

Responding to the Opioid Problem:

New Directions in Research

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Nora D. Volkow, MDDirector

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Addressing the Opioid Crisis:NIDA Research Priorities

• Alternative approaches to treating pain• Preventing opioid (and other drug) use

disorders• Preventing overdose deaths• Treating opioid use disorders• Implementing evidence-based findings

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Pain: Treatment Alternatives

• Biomarkers to detect pain• Abuse deterrent formulations• Alternatives to medications:– Transcranial Magnetic Stimulation– Transcranial Direct Current

Stimulation– High-Definition Transcranial Direct

Current Stimulation– Deep Brain Stimulation

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** **

PREVENTION: Universal Interventions

R. Spoth et al. American Journal of Public Health 2013

** p<.01

Age 25 General Age 25 Opioids0%

4%

8%

12%

16% 15.5%

13.5%

5.4%4.7%

ControlFamily Program

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(narcotics, depressants, stimulants)

Brief universal interventions in early adolescence can reduce prescription drug misuse into young adulthood.

OVERDOSE: User-Friendly Naloxone

• April 3, 2014: FDA approval of naloxone auto-injector (“Evzio”)

• November 18, 2015: FDA approval of naloxone nasal spray (“Narcan Nasal Spray”)

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TREATMENT: Anti-Addiction Medications

• Lower dose; slower release•Mixture formulations (e.g., naloxone and

buprenorphine) • “Prodrug” formulations (only activated

via digestion)• Long-acting (e.g., subdermal buprenorphine

implants)• Vaccines• Alternatives to medication (e.g., TMS)

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Implementation: MAT Utilization

Medication % programs using MAT

(N=345)

% of eligible patients

receiving MAT (w/in adopting

programs)

Methadone 7.8 41.3Buprenorphine

20.9 37.3Tablet naltrexone

22.0 10.9

Knudsen et al, 2011, J Addict Med; 5:21-27.

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Implementation: Addiction Medications as Prevention

-10,000

-8,000

-6,000

-4,000

-2,000

-0 Pati

ents

Tre

ated

Heroin OD Buprenorphine Treatment Methadone Treatment

300-

200-

100-

0-Ove

rdos

e D

eath

s

R Schwartz et al. American Journal of Public Health 20139

Buprenorphine Referral Brief Intervention0

10

20

30

40

50

60

70

80

90

78%

37%45%

% e

ngag

ed in

tre

atm

ent

on t

he 3

0th da

y af

ter

rand

omiz

atio

n

5.4

2.3

Number of days of illicit opiate use per week

5.4

0.9

5.6

2.4

D’Onofrio, et al. JAMA. 2015.

Implementation: MAT in EDs and Treatment

Retention

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Federal Resources

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hhs.gov/opioids/

drugabuse.gov

NIDA Resources

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Speak to Us!

Jack.stein@nih.gov

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