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

2

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”)

6

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)

7

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.

8

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

10

Federal Resources

11

hhs.gov/opioids/

drugabuse.gov

NIDA Resources

12

Speak to Us!

Jack.stein@nih.gov

13