Abuse of prescription opioids, stimulants, and other psychotherapeutic medications presents unique challenges. On the one hand, these drugs can produce serious harm (even death) when not taken as prescribed; on the other, they are powerful clinical allies that can be life saving. Thus, the approach we take and the messages we convey to minimize harm need to be nuanced and multipronged.
This week I have the opportunity to meet with a group of impassioned stakeholders who have gathered in Atlanta, GA for the third annual National Rx Drug Abuse Summit. The Summit brings together people on all sides of the problem, including representatives from government agencies, law enforcement, and the treatment world. This year it is an impressive roster: NIH director Francis Collins is also here, along with Michael Botticelli, acting director of the White House Office of the National Drug Control Policy, and Dr. Thomas R. Frieden, director of the CDC, as well as representatives from the FDA and SAMHSA. The Summit is organized by Operation UNITE, which was founded by Representative Hal Rogers, Chair of the House Appropriations Committee, who is also speaking.
This high level of interest reflects the urgency of the prescription drug abuse problem in the United States. Every day about 105 Americans die from drug overdose, and the majority of those deaths now involve prescription drugs—usually opioid painkillers. In 2012, 2.1 million Americans were addicted to prescription opioids. We are currently also seeing a rise in heroin use and its consequences as people who are addicted to painkillers graduate to those drugs’ cheaper street relative.
Many areas of NIDA research are contributing to reducing this problem, including our advancement of research into pain and efforts to advance pain education in medicine, our research to develop new treatments for opioid addiction, and research to develop new pain treatments including pain medications with less potential for abuse. For example, NIDA is partnering with a pharmaceutical company called Signature Therapeutics to develop an abuse deterrent formulation of the widely abused painkiller OxyContin. This formulation will use prodrug technology—attaching an extension to the opioid molecule that renders it neutral (unable to interact with opioid receptors) if injected, snorted, or smoked; instead it must pass through the digestive system to begin the process of releasing the opioid.
I recently wrote about naloxone and how increased access to this opioid antagonist could help save many people from dying of opioid overdoses. Currently, it is only approved in injectable formulations, but NIDA is supporting several projects to develop intranasal delivery systems. Earlier this month, the FDA approved a hand-held naloxone auto-injector device called Evzio, which can be used by family members or other caregivers and thus also increases its potential to save lives. Naloxone has a high safety profile and no abuse potential; thus, advances in delivery devices that can increase its availability and usability are likely to have a large impact on the opioid (and heroin) overdose epidemic.
While complex, the problem of prescription drug abuse is by no means insurmountable. We are continuously learning more about these drugs’ effects in the brain, and we are converging on new prevention and treatment approaches that, I hope, will soon begin to reverse the alarming statistics. But solving the problem also requires working across agencies and across public and private structures, so it is gratifying to be here in Atlanta among so many policymakers, scientists, and community stakeholders who all share the same goal of reversing this public health epidemic.