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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
1
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
3
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
4
** **
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
5
(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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